MEDICARE: CAROLINE GRACE 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	101Y00000X	Counselor	3001022919	WY
2	101YS0200X	School Counselor	3001022919	WI

General Provider Information

NPI Number	:	1447091533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRACE CORBETT

Provider Business Mailing Address
First Line	:	507 4TH AVE S
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1124
Country	:	US
Telephone Number	:	715-661-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 4TH AVE S
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1124
Country	:	US
Telephone Number	:	715-661-2955
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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Directions to “ CAROLINE GRACE CORBETT ” Practice Location

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