Provider Demographics
NPI:1780012856
Name:HYDE, CHRISTY (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WENTHROP CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4742
Mailing Address - Country:US
Mailing Address - Phone:321-514-9932
Mailing Address - Fax:
Practice Address - Street 1:450 WENTHROP CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4742
Practice Address - Country:US
Practice Address - Phone:321-514-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist