1003398363 NPI number — CHRISTY LYNN MUSSER CCC-SLP

Table of content: CHRISTY LYNN MUSSER CCC-SLP (NPI 1003398363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003398363 NPI number — CHRISTY LYNN MUSSER CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSSER
Provider First Name:
CHRISTY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003398363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18404 SE 37TH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-8240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-369-7765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CENTERPOINTE DR STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-369-7765
Provider Business Practice Location Address Fax Number:
503-406-2259
Provider Enumeration Date:
09/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  015969 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 14201516 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 028067 . This is a "NEW YORK BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 015969 . This is a "OREGON BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 0441191 . This is a "OR TEACHING LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 61197688 . This is a "WASHINGTON BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 05429410 . This is a "MEDICAID PROVIDER ID FOR NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14201516 . This is a "ASHA CCC-SLP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2836966 . This is a "NY TEACHING LICENSE: SPEECH & LANGUAGE DISABILITIES INITIAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 410054 . This is a "OR ESOL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com