Provider Demographics
NPI:1164834016
Name:DEVRIES, CHRISTA
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:BADARACCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1041
Mailing Address - Country:US
Mailing Address - Phone:315-906-0051
Mailing Address - Fax:315-906-0058
Practice Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1041
Practice Address - Country:US
Practice Address - Phone:315-906-0051
Practice Address - Fax:315-906-0058
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist