Provider Demographics
NPI:1235264441
Name:PHELPS, CHRISTINE ANNE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:6759 N. RAVENSWOOD AVE,
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3928
Mailing Address - Country:US
Mailing Address - Phone:773-301-5257
Mailing Address - Fax:773-761-6532
Practice Address - Street 1:6759 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3928
Practice Address - Country:US
Practice Address - Phone:773-301-5257
Practice Address - Fax:773-761-6532
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1460006260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist