Healthcare Provider Details

I. General information

NPI: 1700958337
Provider Name (Legal Business Name): CHRISTINA M SALLUSTIO MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STARNES LOOP RD
GRANT AL
35747-7730
US

IV. Provider business mailing address

1000 STARNES LOOP RD
GRANT AL
35747-7730
US

V. Phone/Fax

Practice location:
  • Phone: 678-362-8586
  • Fax:
Mailing address:
  • Phone: 678-362-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP004827
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: