Healthcare Provider Details

I. General information

NPI: 1811804024
Provider Name (Legal Business Name): CHRISTOPHER W MCCORMICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 EDDY ST
PROVIDENCE RI
02903-4930
US

IV. Provider business mailing address

8 ATLANTIC AVE
NORTH PROVIDENCE RI
02904-3206
US

V. Phone/Fax

Practice location:
  • Phone: 401-368-7113
  • Fax:
Mailing address:
  • Phone:
  • 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: