Provider Demographics
NPI:1659659472
Name:STAPLES, CHRISTA NICOLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:NICOLE
Last Name:STAPLES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HUNTERS CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7994
Mailing Address - Country:US
Mailing Address - Phone:501-580-2030
Mailing Address - Fax:
Practice Address - Street 1:375 HUNTERS CHASE DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7994
Practice Address - Country:US
Practice Address - Phone:501-580-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist