Christine Marie Provencher

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP34708 Issued in CA

Practice address

13223 Black Mountain Rd # 1358
San Diego, CA 92129-2698

Phone

(619) 672-8387

NPI assigned

Mar 15, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1689375669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13223 BLACK MOUNTAIN RD # 1358",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13223 BLACK MOUNTAIN RD # 1358",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292698",
            "telephone_number": "619-672-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP34708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucy Proudfoot
• David Proulx, DAVID PROULX
• Haley Kendall Provan
• Jenessa Rae Provence
• Sara Provence
• Paul Louis Provencio
• Marisa Provenzano, LCSW
• Brooke Proverb
• Provident Home Health Care, Inc.
• Caitlin Reese Suarez Provido

• Speech-Language Pathologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.