Provider Demographics
NPI:1134377401
Name:KLECKNER, CHRISTINA DENISE (MA/CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:KLECKNER
Suffix:
Gender:F
Credentials:MA/CCC/SLP
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:DENISE
Other - Last Name:HARTILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:549 PALOMAR CIR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1949
Mailing Address - Country:US
Mailing Address - Phone:805-733-7306
Mailing Address - Fax:
Practice Address - Street 1:191 BURTON MESA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1400
Practice Address - Country:US
Practice Address - Phone:805-733-4542
Practice Address - Fax:805-733-4392
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist