Provider Demographics
NPI:1073913760
Name:YORK, CHRISTINA MARIE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:YORK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WILDCAT DR STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2826
Mailing Address - Country:US
Mailing Address - Phone:361-704-6630
Mailing Address - Fax:361-704-6581
Practice Address - Street 1:1500 WILDCAT DR STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2826
Practice Address - Country:US
Practice Address - Phone:361-704-6630
Practice Address - Fax:361-704-6581
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80559237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist