Healthcare Provider Details

I. General information

NPI: 1669065579
Provider Name (Legal Business Name): CHRISTINA FIKES MSCCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 DAUPHIN SQ CONN
MOBILE AL
36607-2517
US

IV. Provider business mailing address

6140 CORONADO DR
MOBILE AL
36693-3727
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-1110
  • Fax:
Mailing address:
  • Phone: 251-463-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4120
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: