Provider Demographics
NPI:1720365554
Name:MONAHAN, CHRISTINE ALLISON (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ALLISON
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BARON CT
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3202
Mailing Address - Country:US
Mailing Address - Phone:631-793-5252
Mailing Address - Fax:
Practice Address - Street 1:189 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1704
Practice Address - Country:US
Practice Address - Phone:631-472-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006834-12355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant