Provider Demographics
NPI:1407440589
Name:BRYANT, CHRISTINA D (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA 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:PO BOX 8104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-0104
Mailing Address - Country:US
Mailing Address - Phone:843-908-9809
Mailing Address - Fax:
Practice Address - Street 1:2905 FRUITWOOD LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3614
Practice Address - Country:US
Practice Address - Phone:843-908-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23377235Z00000X
SC4819235Z00000X
FL18710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty