Provider Demographics
NPI:1790133163
Name:STANTON, CHRISTINE LEE (MS, CCC - SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LEE
Last Name:STANTON
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 1:3825 N. BLALOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-502-0547
Mailing Address - Fax:
Practice Address - Street 1:3825 N. BLALOCK DRIVE
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-502-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist