Provider Demographics
NPI:1629130968
Name:BUCKLEY, CHRISTA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAND DOLLAR DR # 9
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8818
Mailing Address - Country:US
Mailing Address - Phone:907-283-2699
Mailing Address - Fax:907-283-2699
Practice Address - Street 1:43335 K BEACH RD
Practice Address - Street 2:SUITE 32-A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8260
Practice Address - Country:US
Practice Address - Phone:907-262-5456
Practice Address - Fax:907-262-5475
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143MAOtherBLUE CROSS BLUE SHIELD #
NC7412652Medicaid