Provider Demographics
NPI:1336379742
Name:CHRISTOPHER, DESIREE (SLPA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:CHIRISTOPHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:970 CALLE AMANECER STE A
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6250
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:
Practice Address - Street 1:970 CALLE AMANECER STE A
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6250
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-21-158898106S00000X
CASPA 456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist