Basic Information
| Provider Information | |||||||||
| NPI: | 1659495034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURISKI | ||||||||
| FirstName: | CORINNE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.,CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PURISKI | ||||||||
| OtherFirstName: | CORINNE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S.,CCC-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 24118 S INDIAN TRL | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604428435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154780471 | ||||||||
| FaxNumber: | 8154780481 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HOUBOLT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604318305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157259992 | ||||||||
| FaxNumber: | 8157259993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.