Provider Demographics
NPI:1467753616
Name:MATTIA, CHRISTINE M (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:MATTIA
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:CASSELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:BEE SKEP LANE
Mailing Address - City:HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12838-0127
Mailing Address - Country:US
Mailing Address - Phone:518-824-1610
Mailing Address - Fax:
Practice Address - Street 1:431 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2914
Practice Address - Country:US
Practice Address - Phone:518-824-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008311-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist