Provider Demographics
NPI:1821317645
Name:WARD, CHRISTINA L (SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6957
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6957
Mailing Address - Country:US
Mailing Address - Phone:478-475-7988
Mailing Address - Fax:478-475-7974
Practice Address - Street 1:3556 RIVERSIDE DR
Practice Address - Street 2:BLDG C
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2509
Practice Address - Country:US
Practice Address - Phone:478-475-7988
Practice Address - Fax:478-475-7974
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist