Provider Demographics
NPI:1588902944
Name:STUCKER, CORINE M (SLPA, MA MGMT)
Entity type:Individual
Prefix:
First Name:CORINE
Middle Name:M
Last Name:STUCKER
Suffix:
Gender:F
Credentials:SLPA, MA MGMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12009 W TONTO ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5711
Mailing Address - Country:US
Mailing Address - Phone:402-470-2322
Mailing Address - Fax:
Practice Address - Street 1:12009 W TONTO ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5711
Practice Address - Country:US
Practice Address - Phone:402-470-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA81642355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant