Provider Demographics
NPI:1043612757
Name:STEPHENS, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W LOWRY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3012
Mailing Address - Country:US
Mailing Address - Phone:502-541-9203
Mailing Address - Fax:
Practice Address - Street 1:175 W LOWRY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:502-541-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist