Provider Demographics
NPI:1184013245
Name:IVY, CHRISIN (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISIN
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5829
Mailing Address - Country:US
Mailing Address - Phone:870-336-0220
Mailing Address - Fax:870-336-0221
Practice Address - Street 1:262 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5829
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:870-336-0221
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARIN PROCESS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist