Basic Information
| Provider Information | |||||||||
| NPI: | 1972633626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STITES | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | MILLER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.,SLP-CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 SONOMA SPRINGS AVE APT 302 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880117108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756540549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 505 S MAIN ST STE 249 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880011243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755275823 | ||||||||
| FaxNumber: | 5755275886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | C4009 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.