Provider Demographics
NPI:1710005699
Name:CHRISTIAN, MARK SCOTT (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 LAKE COOK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5607
Mailing Address - Country:US
Mailing Address - Phone:847-940-9891
Mailing Address - Fax:847-964-9343
Practice Address - Street 1:400 LAKE COOK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5607
Practice Address - Country:US
Practice Address - Phone:847-940-9891
Practice Address - Fax:847-964-9343
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-001042231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist