Provider Demographics
NPI:1659627966
Name:MATT, CHRISTINA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:MATT
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 1:2050 GRAYSON DR
Mailing Address - Street 2:APT. 16106
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7075
Mailing Address - Country:US
Mailing Address - Phone:469-955-3070
Mailing Address - Fax:
Practice Address - Street 1:2050 GRAYSON DR
Practice Address - Street 2:APT. 16106
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7075
Practice Address - Country:US
Practice Address - Phone:469-955-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist