Provider Demographics
NPI:1407138001
Name:MORAN, CHRISTIE LEE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTIE
Middle Name:LEE
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:LEE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 TAUBER RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9585
Mailing Address - Country:US
Mailing Address - Phone:630-887-6381
Mailing Address - Fax:
Practice Address - Street 1:705 TAUBER RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9585
Practice Address - Country:US
Practice Address - Phone:630-887-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist