Provider Demographics
NPI:1447576889
Name:JOHN, CHRISTIE I (SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:I
Last Name:JOHN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:SUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:310-204-2300
Mailing Address - Fax:130-204-0444
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-204-2300
Practice Address - Fax:130-204-0444
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist