Healthcare Provider Details

I. General information

NPI: 1831303171
Provider Name (Legal Business Name): CHRISTA MARIE ESCOBAR MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ROSE HILL DR
CHARLOTTESVILLE VA
22903-5128
US

IV. Provider business mailing address

1102 ROSE HILL DR
CHARLOTTESVILLE VA
22903-5128
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8628
  • Fax: 434-979-8536
Mailing address:
  • Phone: 434-979-8628
  • Fax: 434-979-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004937
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: