Provider Demographics
NPI:1992956262
Name:SCALISE, CHRISTINE MICHELLE (SLP)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:SCALISE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MICHELLE
Other - Last Name:VERANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5703 S 160TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2984
Mailing Address - Country:US
Mailing Address - Phone:321-501-0630
Mailing Address - Fax:
Practice Address - Street 1:5703 S 160TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135
Practice Address - Country:US
Practice Address - Phone:321-501-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist