Provider Demographics
NPI:1154786119
Name:VENT, CHRISTINE (MA-CCCSLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:VENT
Suffix:
Gender:F
Credentials:MA-CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2002
Mailing Address - Country:US
Mailing Address - Phone:319-290-0757
Mailing Address - Fax:
Practice Address - Street 1:1728 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2002
Practice Address - Country:US
Practice Address - Phone:319-290-0757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01014Medicaid