Provider Demographics
NPI:1013317098
Name:BRACKETT, CHRISTIN HOPP (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:HOPP
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:CHRISTIN
Other - Middle Name:LEIGH
Other - Last Name:HOPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1000 SHERYL LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1903
Mailing Address - Country:US
Mailing Address - Phone:336-671-0226
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:SUITE 1105
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-771-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23040235Z00000X
WALL60467776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist