Provider Demographics
NPI:1437660313
Name:BRYANT, CHRISTY A (MS, CCC-SLP, L)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, CCC-SLP, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ROXANA
Mailing Address - State:IL
Mailing Address - Zip Code:62087-1628
Mailing Address - Country:US
Mailing Address - Phone:618-254-5114
Mailing Address - Fax:
Practice Address - Street 1:414 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ROXANA
Practice Address - State:IL
Practice Address - Zip Code:62087-1628
Practice Address - Country:US
Practice Address - Phone:618-254-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
146.006846OtherLICENSE