Healthcare Provider Details

I. General information

NPI: 1184143802
Provider Name (Legal Business Name): CHRISTINE M IVANKIV MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE M IVANKIV MS CCC-SLP

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WHISANT PL
PALM COAST FL
32164-7259
US

IV. Provider business mailing address

7 WHISANT PL
PALM COAST FL
32164-7259
US

V. Phone/Fax

Practice location:
  • Phone: 352-348-1440
  • Fax:
Mailing address:
  • Phone: 352-348-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number028011
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: