Provider Demographics
NPI:1346851896
Name:BRUNSTETTER, CHRISTEN JOY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:JOY
Last Name:BRUNSTETTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 TORI CT
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2483
Mailing Address - Country:US
Mailing Address - Phone:760-415-1913
Mailing Address - Fax:
Practice Address - Street 1:173 BROCKMAN PARK DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-2583
Practice Address - Country:US
Practice Address - Phone:434-946-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist