Provider Demographics
NPI:1457425530
Name:AYCOCK, CHRISTY ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTY
Middle Name:ANNE
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WALNUT CREEK PKWY APT G
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4618
Mailing Address - Country:US
Mailing Address - Phone:919-390-4056
Mailing Address - Fax:
Practice Address - Street 1:1611 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3376
Practice Address - Country:US
Practice Address - Phone:919-852-0702
Practice Address - Fax:919-852-0742
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412537Medicaid