Provider Demographics
NPI:1871324301
Name:DAVIDSON, CHRISTYN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTYN
Middle Name:
Last Name:DAVIDSON
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 1:29 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2201
Mailing Address - Country:US
Mailing Address - Phone:717-314-3542
Mailing Address - Fax:
Practice Address - Street 1:29 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2201
Practice Address - Country:US
Practice Address - Phone:717-314-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist