Provider Demographics
NPI:1730425026
Name:CHANG, CORRINA (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2737
Mailing Address - Country:US
Mailing Address - Phone:408-728-0762
Mailing Address - Fax:
Practice Address - Street 1:4735 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2737
Practice Address - Country:US
Practice Address - Phone:408-728-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist