Provider Demographics
NPI:1619122546
Name:SCOTT, CHRISTINE (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1403
Mailing Address - Country:US
Mailing Address - Phone:631-663-3422
Mailing Address - Fax:
Practice Address - Street 1:169 AVENUE B
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1403
Practice Address - Country:US
Practice Address - Phone:631-663-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist