Provider Demographics
NPI:1992849566
Name:SIDOFF, CHRIS ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRIS
Middle Name:ELLEN
Last Name:SIDOFF
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 1:9433 BEE CAVE RD
Mailing Address - Street 2:BLDG 3 STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-6135
Mailing Address - Country:US
Mailing Address - Phone:512-306-8007
Mailing Address - Fax:512-672-6178
Practice Address - Street 1:9433 BEE CAVE RD
Practice Address - Street 2:BLDG 3 STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-6135
Practice Address - Country:US
Practice Address - Phone:512-306-8007
Practice Address - Fax:512-672-6178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146005190OtherIL PROFESSION LICENSE