Provider Demographics
NPI:1033280730
Name:PAGE, CHRISTY ANN (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 S ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2044
Mailing Address - Country:US
Mailing Address - Phone:417-869-4344
Mailing Address - Fax:
Practice Address - Street 1:940 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3718
Practice Address - Country:US
Practice Address - Phone:417-523-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist