Provider Demographics
NPI:1245742196
Name:CULLUM, CHRISTI L (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:L
Last Name:CULLUM
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 DARREN DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6499
Mailing Address - Country:US
Mailing Address - Phone:817-927-8191
Mailing Address - Fax:
Practice Address - Street 1:301 HUGULEY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7506
Practice Address - Country:US
Practice Address - Phone:682-730-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist