Provider Demographics
NPI:1316067747
Name:SORRELS, CHRISTINA (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SORRELS
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODBINE
Mailing Address - Street 2:#775
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608
Mailing Address - Country:US
Mailing Address - Phone:903-918-5806
Mailing Address - Fax:903-295-5803
Practice Address - Street 1:107 WOODBINE
Practice Address - Street 2:#775
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75608
Practice Address - Country:US
Practice Address - Phone:903-918-5806
Practice Address - Fax:903-295-5803
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist