Provider Demographics
NPI:1053696492
Name:VANDERMEID, CHRISTINE ANN (SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:VANDERMEID
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:PENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:31 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1714
Mailing Address - Country:US
Mailing Address - Phone:585-254-3110
Mailing Address - Fax:
Practice Address - Street 1:31 BRYAN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1714
Practice Address - Country:US
Practice Address - Phone:585-254-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4630-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist