Provider Demographics
NPI:1750922308
Name:BREWER, CHRISTAL A (SLPA)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:A
Last Name:BREWER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:CLAY SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:85923-0403
Mailing Address - Country:US
Mailing Address - Phone:928-210-5645
Mailing Address - Fax:
Practice Address - Street 1:1 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-358-5660
Practice Address - Fax:928-358-5661
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA120982355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA12098OtherSLPA LICENSE NUMBER