Provider Demographics
NPI:1306249032
Name:BEDDOW, CHRISTIE RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:RENEE
Last Name:BEDDOW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:RENEE
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:100 BRIAN CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4340
Mailing Address - Country:US
Mailing Address - Phone:615-751-7284
Mailing Address - Fax:615-301-6196
Practice Address - Street 1:100 BRIAN CIR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4340
Practice Address - Country:US
Practice Address - Phone:615-751-7284
Practice Address - Fax:615-301-6196
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist