Provider Demographics
NPI:1184143802
Name:MANSOUR, CHRISTINE (MS SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS SLP
Mailing Address - Street 1:99 NARROWS RD N APT C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2822
Mailing Address - Country:US
Mailing Address - Phone:352-348-1440
Mailing Address - Fax:
Practice Address - Street 1:99 NARROWS RD N APT C
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:352-348-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028011235Z00000X
FL16573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist