Provider Demographics
NPI:1801466487
Name:WHITE, CHRISTINA LEANNE LAYTON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEANNE LAYTON
Last Name:WHITE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LEANNE
Other - Last Name:LAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1008 CURTISS ST APT A4
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4786
Mailing Address - Country:US
Mailing Address - Phone:214-907-0959
Mailing Address - Fax:
Practice Address - Street 1:421 HARRISON ST STE C
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1461
Practice Address - Country:US
Practice Address - Phone:773-573-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1104947704Medicaid