Provider Demographics
NPI:1376980029
Name:CHRISTENSON, MERILYN JUANICE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERILYN
Middle Name:JUANICE
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COPPER LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-8139
Mailing Address - Country:US
Mailing Address - Phone:575-528-2200
Mailing Address - Fax:575-524-2575
Practice Address - Street 1:2325 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3902
Practice Address - Country:US
Practice Address - Phone:575-527-4900
Practice Address - Fax:575-523-1756
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist