Healthcare Provider Details

I. General information

NPI: 1982953394
Provider Name (Legal Business Name): CHRISTI M IRWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTI M MARTIN MS CCC SLP

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH ST
BROOKINGS OR
97415-9392
US

IV. Provider business mailing address

500 5TH ST
BROOKINGS OR
97415-9392
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-2000
  • Fax:
Mailing address:
  • Phone: 209-217-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: