Provider Demographics
NPI:1598897019
Name:BREEDEN, CHRISTINA DELAO (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DELAO
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 SADDLE FORK CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-6068
Mailing Address - Country:US
Mailing Address - Phone:505-373-9270
Mailing Address - Fax:
Practice Address - Street 1:1001 S DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4710
Practice Address - Country:US
Practice Address - Phone:505-546-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist