MEDICARE: CHRISTINA ROSE BARNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL014130	PA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023565116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ROSE BARNES

Provider Business Mailing Address
First Line	:	900 S 51ST ST APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3249
Country	:	US
Telephone Number	:	908-616-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	12265 TOWNSEND RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	908-616-4105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	06/01/2021

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Directions to “ CHRISTINA ROSE BARNES ” Practice Location

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