Provider Demographics
NPI:1649909722
Name:WILLIS, CHRISTINA SUZANNE (MS SLP-INTERN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUZANNE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MS SLP-INTERN
Other - Prefix:
Other - First Name:CHRISTY ANNE
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1431 GREENWAY DR STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2444
Mailing Address - Country:US
Mailing Address - Phone:214-467-9787
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR STE 500
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2444
Practice Address - Country:US
Practice Address - Phone:214-467-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist