Provider Demographics
NPI:1598181638
Name:CLAGETT, CHRISTINA ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:CLAGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13760 TRIADELPHIA MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1022
Mailing Address - Country:US
Mailing Address - Phone:301-641-6707
Mailing Address - Fax:
Practice Address - Street 1:2470 LONGSTONE LN STE H
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1512
Practice Address - Country:US
Practice Address - Phone:410-442-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist