Provider Demographics
NPI:1518542273
Name:MATTICE, CHRISTIE (HAD,BC-HIS)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:MATTICE
Suffix:
Gender:F
Credentials:HAD,BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7310
Mailing Address - Country:US
Mailing Address - Phone:970-385-7272
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST STE 205
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7310
Practice Address - Country:US
Practice Address - Phone:970-385-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000431237700000X, 2355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant