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General NPI Number Information
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NPI Number | 1639422850
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Entity Type | Individual
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Provider Name | CORRIE BETH RAPHAEL CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2208 CAMINO RAMON SUITE B
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City | SAN RAMON
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State | CA
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Zip | 94583-1328
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Country | US
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Telephone | 925-830-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 39 EL GAVILAN RD
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City | ORINDA
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State | CA
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Zip | 94563-1907
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Country | US
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Telephone | 925-528-9976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 15951
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License Number State | CA
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