Provider Demographics
NPI:1871722504
Name:RED, CHRISTINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:RED
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 1:6673 OAKTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4932
Mailing Address - Country:US
Mailing Address - Phone:703-307-4448
Mailing Address - Fax:571-261-1980
Practice Address - Street 1:6673 OAKTON AVE
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-4932
Practice Address - Country:US
Practice Address - Phone:703-307-4448
Practice Address - Fax:571-261-1980
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist