Provider Demographics
NPI:1558487165
Name:CHRISTIANSON-LARSON, TAMI (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:
Last Name:CHRISTIANSON-LARSON
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12481 80TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:ND
Mailing Address - Zip Code:58260-9564
Mailing Address - Country:US
Mailing Address - Phone:701-993-8485
Mailing Address - Fax:
Practice Address - Street 1:106B DIVISION AVE. N.
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:701-265-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51180Medicaid
ND652OtherSTATE LICENSE NUMBER