Provider Demographics
NPI:1174799407
Name:ELDRIDGE, CORINNE (MCD, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:MCD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3349
Mailing Address - Country:US
Mailing Address - Phone:870-633-8377
Mailing Address - Fax:
Practice Address - Street 1:400 W LYNN ST
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-3405
Practice Address - Country:US
Practice Address - Phone:870-734-5010
Practice Address - Fax:870-734-5014
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist