Provider Demographics
NPI:1841666476
Name:FETTER, CRISTINA (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:FETTER
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 CYPRESS WATERS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4594
Practice Address - Country:US
Practice Address - Phone:866-217-0265
Practice Address - Fax:844-819-9147
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006128A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist