Provider Demographics
NPI:1881858488
Name:LEVINE, CHRISTY CHESNUT (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:CHESNUT
Last Name:LEVINE
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 1:5828 S 78TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8606
Mailing Address - Country:US
Mailing Address - Phone:508-654-7478
Mailing Address - Fax:
Practice Address - Street 1:5828 S 78TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-8606
Practice Address - Country:US
Practice Address - Phone:508-654-7478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3076235Z00000X
OK4102235Z00000X
CA18672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist