Provider Demographics
NPI:1396262242
Name:HOMER, CHRISTINA LARREA (MA,SLP/CCC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LARREA
Last Name:HOMER
Suffix:
Gender:F
Credentials:MA,SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WESTER ROSS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1139
Mailing Address - Country:US
Mailing Address - Phone:512-568-4825
Mailing Address - Fax:512-343-0223
Practice Address - Street 1:505 WESTER ROSS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-1139
Practice Address - Country:US
Practice Address - Phone:512-568-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist