Provider Demographics
NPI:1962947275
Name:THWAITES, CHRISTY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:THWAITES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:ELIZABETH
Other - Last Name:TITCHENAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:710 LAUREL AVE APT C5
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4138
Mailing Address - Country:US
Mailing Address - Phone:707-337-2911
Mailing Address - Fax:
Practice Address - Street 1:65 TOWER RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4000
Practice Address - Country:US
Practice Address - Phone:650-573-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist