Provider Demographics
NPI:1366648958
Name:HORDE, CHRISTINA (SLP CCC LIC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HORDE
Suffix:
Gender:F
Credentials:SLP CCC LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 W 99TH ST
Mailing Address - Street 2:APT 1 SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2159
Mailing Address - Country:US
Mailing Address - Phone:773-445-1375
Mailing Address - Fax:
Practice Address - Street 1:1520 W 99TH ST
Practice Address - Street 2:APT 1 SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2159
Practice Address - Country:US
Practice Address - Phone:773-445-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILH63011360957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist