Provider Demographics
NPI:1770980211
Name:REW, CHRISTY J (MED, MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:J
Last Name:REW
Suffix:
Gender:F
Credentials:MED, 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 1:1915 MULLER RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8572
Mailing Address - Country:US
Mailing Address - Phone:803-714-7092
Mailing Address - Fax:
Practice Address - Street 1:1915 MULLER RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8572
Practice Address - Country:US
Practice Address - Phone:803-714-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-27
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3373235Z00000X
VA2202003054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist