Provider Demographics
NPI:1376679621
Name:WAHL, CHRISTOPHER D (AUD CCCA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:WAHL
Suffix:
Gender:M
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36305 N GANTZEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7326
Mailing Address - Country:US
Mailing Address - Phone:804-284-6004
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD STE F600
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4667
Practice Address - Country:US
Practice Address - Phone:602-863-4203
Practice Address - Fax:602-863-4216
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1806231H00000X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
109254Medicare UPIN