Provider Demographics
NPI:1457569428
Name:VIGGIANO, CHRISTINE MARY (MA,CCC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARY
Last Name:VIGGIANO
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3437
Mailing Address - Country:US
Mailing Address - Phone:610-446-7924
Mailing Address - Fax:
Practice Address - Street 1:1130 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3437
Practice Address - Country:US
Practice Address - Phone:610-446-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004032L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00193174 0002Medicaid