Provider Demographics
NPI:1508152620
Name:MCCONNELL, CHRISTINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 SPRINGDALE ST
Mailing Address - Street 2:#236
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4600
Mailing Address - Country:US
Mailing Address - Phone:310-753-8071
Mailing Address - Fax:
Practice Address - Street 1:980 ROOSEVELT
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3672
Practice Address - Country:US
Practice Address - Phone:949-333-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist