Provider Demographics
NPI:1790099745
Name:WALDEN, CHRISTOPHER BLAKE (HIS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BLAKE
Last Name:WALDEN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NE 25TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5675
Mailing Address - Country:US
Mailing Address - Phone:352-671-3277
Mailing Address - Fax:352-671-8164
Practice Address - Street 1:1111 NE 25TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5675
Practice Address - Country:US
Practice Address - Phone:352-671-3277
Practice Address - Fax:352-671-8164
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4087237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist