Basic Information
| Provider Information | |||||||||
| NPI: | 1801338108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LESTER | ||||||||
| FirstName: | CORRINE | ||||||||
| MiddleName: | ADAME | ||||||||
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| OtherLastName: | LESTER | ||||||||
| OtherFirstName: | CORRINE | ||||||||
| OtherMiddleName: | ADAME | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | SPEECH AND LANGUAGE | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1268 TUSCANY DR | ||||||||
| Address2: | |||||||||
| City: | DINUBA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936183171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593972522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7111 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592246350 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2016 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12134650 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.