Provider Demographics
NPI:1366803249
Name:MENTRIKOSKI, CHRISTIN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:
Last Name:MENTRIKOSKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:
Other - Last Name:GOELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5740 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1580
Mailing Address - Country:US
Mailing Address - Phone:215-514-3305
Mailing Address - Fax:
Practice Address - Street 1:4759 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-1921
Practice Address - Country:US
Practice Address - Phone:202-349-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist