Provider Demographics
NPI:1992297527
Name:HUCKVALE, CORINNE NORTON (MS)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:NORTON
Last Name:HUCKVALE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:MARTEEN
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13947 S NEWBURG DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 WEBB DR STE 400
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3921
Practice Address - Country:US
Practice Address - Phone:863-547-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 106S00000X
FLSA21355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist