Provider Demographics
NPI:1508440777
Name:ROOSMALEN, CHRISTOPHER ANTHONY (PHD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANTHONY
Last Name:ROOSMALEN
Suffix:
Gender:M
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 VALLEY CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-4320
Mailing Address - Country:US
Mailing Address - Phone:915-222-2365
Mailing Address - Fax:
Practice Address - Street 1:6420 ESCONDIDO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2977
Practice Address - Country:US
Practice Address - Phone:915-581-3345
Practice Address - Fax:915-833-4581
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A