Provider Demographics
NPI:1639424757
Name:CONDE, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CONDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 N LAWNDALE AVE
Mailing Address - Street 2:APT. 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4136
Mailing Address - Country:US
Mailing Address - Phone:773-218-0797
Mailing Address - Fax:
Practice Address - Street 1:3823 N LAWNDALE AVE
Practice Address - Street 2:APT. 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4136
Practice Address - Country:US
Practice Address - Phone:773-218-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist