Provider Demographics
NPI:1447405493
Name:MICKELS DERINGER, CHRISTY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:LYNN
Last Name:MICKELS DERINGER
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 1:1123 COUNTY HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:FLY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13337-2703
Mailing Address - Country:US
Mailing Address - Phone:607-435-0691
Mailing Address - Fax:
Practice Address - Street 1:1123 COUNTY HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:FLY CREEK
Practice Address - State:NY
Practice Address - Zip Code:13337-2703
Practice Address - Country:US
Practice Address - Phone:607-435-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist