Basic Information
| Provider Information | |||||||||
| NPI: | 1427375856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAMON | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | MEREDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1099 PREVOST CT | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951255723 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 CHARLEVOIX DR SE | ||||||||
| Address2: | SUITE 2000 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495467085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006848049 | ||||||||
| FaxNumber: | 8003251326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2010 | ||||||||
| LastUpdateDate: | 02/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8831 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP17054 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP01047 | RI | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 105501 | TX | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 13220 | OR | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.