Provider Demographics
NPI:1467547018
Name:STANDARD, CHRISTINE M (AUD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:STANDARD
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 1:515 E GRANT ST STE 114
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-4510
Mailing Address - Country:US
Mailing Address - Phone:309-836-5031
Mailing Address - Fax:309-837-2920
Practice Address - Street 1:515 E GRANT ST STE 114
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-4510
Practice Address - Country:US
Practice Address - Phone:309-836-5031
Practice Address - Fax:309-837-2920
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000837231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212993 K25007Medicare ID - Type UnspecifiedAUDIOLOGIST