Provider Demographics
NPI:1902920366
Name:AUSTIN, CHRISTY NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:NICOLE
Last Name:AUSTIN
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 1:5139 GREENE ROAD 707
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-9425
Mailing Address - Country:US
Mailing Address - Phone:870-236-2554
Mailing Address - Fax:870-236-4783
Practice Address - Street 1:6012 GREENE ROAD 707
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7826
Practice Address - Country:US
Practice Address - Phone:870-236-4783
Practice Address - Fax:870-236-4783
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T614Medicare ID - Type UnspecifiedSPEECH PATHOLOGY