Provider Demographics
NPI:1043482318
Name:IDAR, CHRISTINA D (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:IDAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:D
Other - Last Name:IDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3403 LURA LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2358
Mailing Address - Country:US
Mailing Address - Phone:210-435-7373
Mailing Address - Fax:
Practice Address - Street 1:6655 FIRST PARK TEN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4308
Practice Address - Country:US
Practice Address - Phone:210-737-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist