Provider Demographics
NPI:1104932763
Name:BARBER, CHRISTINE EHMKE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EHMKE
Last Name:BARBER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GUENTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5523 CEDAR PINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-461-3999
Mailing Address - Fax:
Practice Address - Street 1:11602 LAKE UNDERHILL ROAD
Practice Address - Street 2:STE 129
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4460
Practice Address - Country:US
Practice Address - Phone:407-281-0441
Practice Address - Fax:407-281-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885723700Medicaid
FL103035000Medicaid