Provider Demographics
NPI:1386899037
Name:CONDURSO, CHRISTINE (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CONDURSO
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:TRIALONAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:170 STATESIR PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6108
Mailing Address - Country:US
Mailing Address - Phone:917-587-4485
Mailing Address - Fax:
Practice Address - Street 1:170 STATESIR PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6108
Practice Address - Country:US
Practice Address - Phone:917-587-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014206-1235Z00000X
NJ41YS00685700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist