Provider Demographics
NPI:1588072185
Name:JOHNSON-LISCIO, CHRISTINE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOHNSON-LISCIO
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1109
Mailing Address - Country:US
Mailing Address - Phone:978-790-5578
Mailing Address - Fax:
Practice Address - Street 1:15 FOX HILL RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1109
Practice Address - Country:US
Practice Address - Phone:978-790-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000723Medicaid