Provider Demographics
NPI:1962658518
Name:DOUGLAS, CHRISTY LEIGH (MCD;CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEIGH
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MCD;CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 DEERBORN DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-8910
Mailing Address - Country:US
Mailing Address - Phone:870-239-0215
Mailing Address - Fax:
Practice Address - Street 1:1701 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4048
Practice Address - Country:US
Practice Address - Phone:870-239-3885
Practice Address - Fax:870-239-0976
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist