Provider Demographics
NPI:1174080642
Name:BREWER, CHRISTY TARYN
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:TARYN
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16566 BRANCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1845
Mailing Address - Country:US
Mailing Address - Phone:636-346-9634
Mailing Address - Fax:
Practice Address - Street 1:3260 BAISCH DR
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-5046
Practice Address - Country:US
Practice Address - Phone:636-586-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist