Provider Demographics
NPI:1659847374
Name:CHILDRESS, MARIA CHRISTINA (AUD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CHRISTINA
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2203 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6274
Mailing Address - Country:US
Mailing Address - Phone:217-898-0790
Mailing Address - Fax:
Practice Address - Street 1:809 N NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3058
Practice Address - Country:US
Practice Address - Phone:217-355-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000944231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist