Provider Demographics
NPI:1619321601
Name:CHRISTENSEN, TYLER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
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 1:4401 HARRISON BLVD
Mailing Address - Street 2:MCKAY-DEE INPATIENT REHAB
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3195
Mailing Address - Country:US
Mailing Address - Phone:801-387-2288
Mailing Address - Fax:
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:MCKAY-DEE INPATIENT REHAB
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9092382-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist