Provider Demographics
NPI:1417551326
Name:RUSSELL, CHRISTINE TIEN (AUD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:TIEN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BLUE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1733
Mailing Address - Country:US
Mailing Address - Phone:832-560-8988
Mailing Address - Fax:
Practice Address - Street 1:4000 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4794
Practice Address - Country:US
Practice Address - Phone:602-265-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81153231H00000X
AZDA12581231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist