Provider Demographics
NPI:1588809388
Name:GIBSON, CHRISTINA SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUSAN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 TODD HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5916
Mailing Address - Country:US
Mailing Address - Phone:845-227-1834
Mailing Address - Fax:845-227-1822
Practice Address - Street 1:23 SPACKENKILL RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5317
Practice Address - Country:US
Practice Address - Phone:845-462-0079
Practice Address - Fax:845-462-0081
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0196111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist