Provider Demographics
NPI:1649600560
Name:MOON, CHRISTY M
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:MOON
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 1:1500 S LAKE PARK AVE
Mailing Address - Street 2:MANAGED CARE DEPARTMANT
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6638
Mailing Address - Country:US
Mailing Address - Phone:219-947-6113
Mailing Address - Fax:219-947-6503
Practice Address - Street 1:4321 FIR STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46342
Practice Address - Country:US
Practice Address - Phone:219-392-7665
Practice Address - Fax:219-392-7993
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002475A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist