Provider Demographics
NPI:1952070989
Name:KONDERLA, CHRISTA LYNNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LYNNE
Last Name:KONDERLA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:LYNNE
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1812 WELSH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4800
Mailing Address - Country:US
Mailing Address - Phone:979-764-5433
Mailing Address - Fax:979-764-5489
Practice Address - Street 1:1812 WELSH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4800
Practice Address - Country:US
Practice Address - Phone:979-764-5433
Practice Address - Fax:979-764-5489
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist