Provider Demographics
NPI:1417199522
Name:STAUBLE, CHRISTINA B (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:B
Last Name:STAUBLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:STAUBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9 CANDLEWOOD HBR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1518
Mailing Address - Country:US
Mailing Address - Phone:203-775-1151
Mailing Address - Fax:
Practice Address - Street 1:9 CANDLEWOOD HBR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1518
Practice Address - Country:US
Practice Address - Phone:203-775-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12566861235Z00000X
CT004020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist