Doctor Name: | MISS COREY ELYSSE KILCULLEN |
NPI Number: | 1588838320 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 8035 |
Business Practice Address: | 7110 Brighton Park Dr Suite 400 Pmb 168 Mint Hill, NC - 282277987 |
Business Phone Number: | 7049650783 |
Business Fax Number: | |
Mailing Address: | 1817 Ewing Ave, Apt. B CHARLOTTE |
State: | NC |
Postal Code: | 282035739 |
Phone Number: | 8284036210 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2008 |
NPI Last Update Date: | 04/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8035 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |