Individual
MR. CHRISTOPHER M WYETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
1201 BROAD ROCK BLVD, RICHMOND, VA 23249-0001
(804) 675-5000
Mailing address
1201 BROAD ROCK BLVD, RICHMOND, VA 23249-0001
(804) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008952
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14153091
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE
—
01
—
2202008952
COMMONWEALTH OF VIRGINIA SLP LICENSE
VA
Enumeration date
07/11/2019
Last updated
03/17/2021
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