Provider Demographics
NPI:1922311729
Name:CIPPERLEY, CHRISTINA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:CIPPERLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:DESMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1003 CLOVERLAWN RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9507
Mailing Address - Country:US
Mailing Address - Phone:518-424-8345
Mailing Address - Fax:
Practice Address - Street 1:1003 CLOVERLAWN RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-9507
Practice Address - Country:US
Practice Address - Phone:518-424-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03346123Medicaid