1013317098 NPI number — MRS. CHRISTIN HOPP BRACKETT M.S., CCC-SLP

Table of content: MRS. CHRISTIN HOPP BRACKETT M.S., CCC-SLP (NPI 1013317098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013317098 NPI number — MRS. CHRISTIN HOPP BRACKETT M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRACKETT
Provider First Name:
CHRISTIN
Provider Middle Name:
HOPP
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOPP
Provider Other First Name:
CHRISTIN
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013317098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 SHERYL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTUS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73521-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-671-0226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 N SUNRISE AVE
Provider Second Line Business Practice Location Address:
SUITE 1105
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-771-8255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  23040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: LL60467776 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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