Provider Demographics
NPI:1053400036
Name:NICK, CHRISTA LYNN (SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:LYNN
Last Name:NICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CHRISTA
Other - Middle Name:LYNN
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:29226 N CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9507
Mailing Address - Country:US
Mailing Address - Phone:847-487-2408
Mailing Address - Fax:
Practice Address - Street 1:165 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1783
Practice Address - Country:US
Practice Address - Phone:847-459-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist