Provider Demographics
NPI:1467510446
Name:CHRISTENSEN, SHARON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 ADMIRAL DEWEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1347
Mailing Address - Country:US
Mailing Address - Phone:505-265-4996
Mailing Address - Fax:
Practice Address - Street 1:601 4TH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3840
Practice Address - Country:US
Practice Address - Phone:505-247-1012
Practice Address - Fax:505-843-9435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist