Provider Demographics
NPI:1285639807
Name:CHRISTENSEN, BRANT R (AUD)
Entity Type:Individual
Prefix:MR
First Name:BRANT
Middle Name:R
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21804
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7073
Mailing Address - Country:US
Mailing Address - Phone:307-426-4327
Mailing Address - Fax:307-426-3277
Practice Address - Street 1:7215 COMMONS CIR UNIT C
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2666
Practice Address - Country:US
Practice Address - Phone:307-426-4327
Practice Address - Fax:307-426-3277
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA963231HA2400X, 231HA2500X, 237600000X
WYA-963231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112860402Medicaid
WY308889Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER