Provider Demographics
NPI:1447420161
Name:AYLSWORTH, CHRISTIE LYNN (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:LYNN
Last Name:AYLSWORTH
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 1:7106 LYNN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-2095
Mailing Address - Country:US
Mailing Address - Phone:210-722-0141
Mailing Address - Fax:
Practice Address - Street 1:10515 GULFDALE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3602
Practice Address - Country:US
Practice Address - Phone:210-340-2627
Practice Address - Fax:210-340-6437
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist