Provider Demographics
NPI:1407120975
Name:STEVENSON, CHRISTINA ROSE JENKS (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSE JENKS
Last Name:STEVENSON
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 1:326 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2205
Mailing Address - Country:US
Mailing Address - Phone:541-316-8005
Mailing Address - Fax:
Practice Address - Street 1:326 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2205
Practice Address - Country:US
Practice Address - Phone:541-316-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist