Provider Demographics
NPI:1003474370
Name:BISCONER, CHRISTY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MARIE
Last Name:BISCONER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-8361
Mailing Address - Country:US
Mailing Address - Phone:360-841-8096
Mailing Address - Fax:360-326-1599
Practice Address - Street 1:647 GUN CLUB RD
Practice Address - Street 2:C/O DYNAMIC SPEECH & LANGUAGE THERAPY LLC
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8361
Practice Address - Country:US
Practice Address - Phone:360-841-8096
Practice Address - Fax:360-326-1599
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60983851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60983851OtherDEPARTMENT OF HEALTH
14202242OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION