Basic Information
| Provider Information | |||||||||
| NPI: | 1104932763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARBER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | EHMKE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUENTHER | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5523 CEDAR PINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074613999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11602 LAKE UNDERHILL ROAD | ||||||||
| Address2: | STE 129 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328254460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072810441 | ||||||||
| FaxNumber: | 4072810422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 5679 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 885723700 | 05 | FL | MEDICAID | 103035000 | 05 | FL | MEDICAID |