Provider Demographics
NPI:1912529579
Name:JUDE, CORRA DEE RACHAEL (MSC CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORRA
Middle Name:DEE RACHAEL
Last Name:JUDE
Suffix:
Gender:F
Credentials:MSC CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 COACHELLA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-3435
Mailing Address - Country:US
Mailing Address - Phone:808-724-4986
Mailing Address - Fax:
Practice Address - Street 1:926 COACHELLA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-3435
Practice Address - Country:US
Practice Address - Phone:808-724-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty