Provider Demographics
NPI:1316160187
Name:FOREMAN, CHRISTINA GAYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:GAYLE
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:860-285-0881
Practice Address - Street 1:46 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1479
Practice Address - Country:US
Practice Address - Phone:860-285-0881
Practice Address - Fax:860-285-0881
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist