Provider Demographics
NPI:1689263055
Name:MAIKISCH, CHRISTA
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:MAIKISCH
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 1:12920 CENTRAL AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5888
Mailing Address - Country:US
Mailing Address - Phone:310-753-8072
Mailing Address - Fax:
Practice Address - Street 1:3294 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2426
Practice Address - Country:US
Practice Address - Phone:562-988-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist