Provider Demographics
NPI:1457650715
Name:SKUBURDIS, CHRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:SKUBURDIS
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 1:2043 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3901
Mailing Address - Country:US
Mailing Address - Phone:203-849-0021
Mailing Address - Fax:203-849-0021
Practice Address - Street 1:2043 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3901
Practice Address - Country:US
Practice Address - Phone:203-849-0021
Practice Address - Fax:203-849-0021
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-040890235Z00000X
CT003024235Z00000X
NY009912-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT03-040890OtherSPEECH PATHOLOGIST LICENSE