Provider Demographics
NPI:1003398363
Name:MUSSER, CHRISTY LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:MUSSER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18404 SE 37TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8240
Mailing Address - Country:US
Mailing Address - Phone:714-369-7765
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR STE 400
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8661
Practice Address - Country:US
Practice Address - Phone:714-369-7765
Practice Address - Fax:503-406-2259
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015969235Z00000X
14201516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028067OtherNEW YORK BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY
OR015969OtherOREGON BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY
OR0441191OtherOR TEACHING LICENSE
WA61197688OtherWASHINGTON BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY
NY05429410OtherMEDICAID PROVIDER ID FOR NY
14201516OtherASHA CCC-SLP
NY2836966OtherNY TEACHING LICENSE: SPEECH & LANGUAGE DISABILITIES INITIAL
OR410054OtherOR ESOL