1629130968 NPI number — CHRISTA BUCKLEY MS, CCC-SLP

Table of content: CHRISTA BUCKLEY MS, CCC-SLP (NPI 1629130968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629130968 NPI number — CHRISTA BUCKLEY MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCKLEY
Provider First Name:
CHRISTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, 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:
1629130968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 SAND DOLLAR DR # 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENAI
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99611-8818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-283-2699
Provider Business Mailing Address Fax Number:
907-283-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43335 K BEACH RD
Provider Second Line Business Practice Location Address:
SUITE 32-A
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-8260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-262-5456
Provider Business Practice Location Address Fax Number:
907-262-5475
Provider Enumeration Date:
12/14/2006

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:  221 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143MA . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7412652 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com