Healthcare Provider Details

I. General information

NPI: 1609420611
Provider Name (Legal Business Name): CORINNE LANDERS M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S ALVARADO ST
LOS ANGELES CA
90057-2915
US

IV. Provider business mailing address

4581 HUNTINGTON WOODS
WOOSTER OH
44691-7225
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: