Provider Demographics
NPI:1518048669
Name:POMERLYAN, CHRISTA ANDERSON (CCC-SLP, CERT AVT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:ANDERSON
Last Name:POMERLYAN
Suffix:
Gender:F
Credentials:CCC-SLP, CERT AVT
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:850 E BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5842
Mailing Address - Country:US
Mailing Address - Phone:864-675-6421
Mailing Address - Fax:
Practice Address - Street 1:128 CAPERS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2805
Practice Address - Country:US
Practice Address - Phone:864-205-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist