Provider Demographics
NPI:1447391248
Name:WALSH, CHRISTINE A (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:WALSH
Suffix:
Gender:
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:GIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5112
Mailing Address - Country:US
Mailing Address - Phone:631-664-5896
Mailing Address - Fax:
Practice Address - Street 1:35 CARMAN RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5651
Practice Address - Country:US
Practice Address - Phone:631-549-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008593-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0120168OtherGHI
NY02733186Medicaid
NYP3652821OtherOXFORD