Individual
CHRISTINA N PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
13221 N 30TH ST, PHOENIX, AZ 85032-6027
(623) 225-6164
Mailing address
13221 N 30TH ST, PHOENIX, AZ 85032-6027
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1656
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
713637
—
AZ
Enumeration date
12/11/2006
Last updated
08/09/2012
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