Provider Demographics
NPI:1346799335
Name:RESOLUS, CHRISTINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RESOLUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 GEORGE BUSBEE PKWY NW STE 11-318
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4981
Mailing Address - Country:US
Mailing Address - Phone:770-954-5655
Mailing Address - Fax:
Practice Address - Street 1:2615 GEORGE BUSBEE PKWY NW STE 11-318
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4981
Practice Address - Country:US
Practice Address - Phone:770-954-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP008749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty