MEDICARE: EMILY CORBETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2204000150	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2204000150	OTHER	VA	VA SLP LICENSE NUMBER

General Provider Information

NPI Number	:	1831676766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CORBETT

Provider Business Mailing Address
First Line	:	1602 BELLE VIEW BLVD # 3189
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 MOUNT VERNON AVE UNIT 2321
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-0200
Country	:	US
Telephone Number	:	716-969-5469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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Directions to “ EMILY CORBETT ” Practice Location

Language	Start Address	Practice Location

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