Provider Demographics
NPI:1568508240
Name:MCGREW, CHRISTINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MCGREW
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:36 S ROWENA ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-2656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1833 MILLENIUM WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1510
Practice Address - Country:US
Practice Address - Phone:208-898-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSLP-1297OtherSTATE OF IDAHO
UT2766684102OtherSTATE LICENSE
01080693OtherASHA