Provider Demographics
NPI:1972819860
Name:RADCLIFFE, CHRISTINE MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LOS ROBLES DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7890
Mailing Address - Country:US
Mailing Address - Phone:512-791-2383
Mailing Address - Fax:
Practice Address - Street 1:12710 RESEARCH BLVD STE 392
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4379
Practice Address - Country:US
Practice Address - Phone:512-331-4115
Practice Address - Fax:512-331-8176
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist