Provider Demographics
NPI:1164824165
Name:VON WERNICH, CHRISTINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:VON WERNICH
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 1:7002 CUPSEED LN
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-6024
Mailing Address - Country:US
Mailing Address - Phone:863-242-1163
Mailing Address - Fax:
Practice Address - Street 1:7002 CUPSEED LN
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:FL
Practice Address - Zip Code:34773-6024
Practice Address - Country:US
Practice Address - Phone:863-242-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL235Z00000XMedicaid
FL235Z00000XMedicare UPIN
FL235Z00000XMedicaid
FL235Z00000XMedicare PIN