Basic Information
Provider Information | |||||||||
NPI: | 1013317098 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRACKETT | ||||||||
FirstName: | CHRISTIN | ||||||||
MiddleName: | HOPP | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOPP | ||||||||
OtherFirstName: | CHRISTIN | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | SLP | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1000 SHERYL LN | ||||||||
Address2: |   | ||||||||
City: | ALTUS | ||||||||
State: | OK | ||||||||
PostalCode: | 735211903 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3366710226 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 151 N SUNRISE AVE | ||||||||
Address2: | SUITE 1105 | ||||||||
City: | ROSEVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 956612924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9167718255 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/27/2014 | ||||||||
LastUpdateDate: | 09/28/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 23040 | CA | N |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   | 235Z00000X | LL60467776 | WA | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.