Provider Demographics
NPI:1396882247
Name:POULTON, CHRISTIE LOUISE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LOUISE
Last Name:POULTON
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 1:1148 9TH ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5242
Mailing Address - Country:US
Mailing Address - Phone:310-863-0252
Mailing Address - Fax:
Practice Address - Street 1:1148 9TH ST
Practice Address - Street 2:SUITE 18
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5242
Practice Address - Country:US
Practice Address - Phone:310-863-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist