Provider Demographics
NPI:1669762647
Name:STAVESKI, CHRISTINA K (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:K
Last Name:STAVESKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLDE ORCHARD LANE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2468
Mailing Address - Country:US
Mailing Address - Phone:585-388-9190
Mailing Address - Fax:
Practice Address - Street 1:3 OLDE ORCHARD LN
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2468
Practice Address - Country:US
Practice Address - Phone:585-388-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5529-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist