Provider Demographics
NPI:1154725422
Name:DESMOND, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DESMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PERRY AVE
Mailing Address - Street 2:MOUNTAIN VIEW MIDDLE SCHOOL 6TH GRADE
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-5139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 PERRY AVE
Practice Address - Street 2:MOUNTAIN VIEW MIDDLE SCHOOL 6TH GRADE
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-5139
Practice Address - Country:US
Practice Address - Phone:360-473-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA474267B235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist