Basic Information
Provider Information
NPI: 1952300683
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONRAD
FirstName: CHRISTIE-ANN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 205 DEER MEADOW DR
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152412253
CountryCode: US
TelephoneNumber: 7249414434
FaxNumber:  
Practice Location
Address1: 205 DEER MEADOW DR
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152412253
CountryCode: US
TelephoneNumber: 7249414434
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSL002049LPAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
001760763000505PA MEDICAID


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