Provider Demographics
NPI:1609192434
Name:MCDERMOTT, CHRISTINE ANN (MA, CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MA, CCC SLP
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:BEVERIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC, SLP
Mailing Address - Street 1:226 S. WOODS MILL RD.
Mailing Address - Street 2:SUITE 37W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3442
Mailing Address - Country:US
Mailing Address - Phone:314-523-5390
Mailing Address - Fax:
Practice Address - Street 1:226 S. WOODS MILL RD.
Practice Address - Street 2:SUITE 37W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-523-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist