Provider Demographics
NPI:1790290252
Name:CHRISTENSEN, ELLEN CAROLINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CAROLINE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CAROLINE
Other - Last Name:AVOLETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 1/2 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1828
Mailing Address - Country:US
Mailing Address - Phone:217-653-3889
Mailing Address - Fax:
Practice Address - Street 1:800 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1436
Practice Address - Country:US
Practice Address - Phone:217-942-6946
Practice Address - Fax:217-942-9012
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001659231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147001659OtherIL LICENSURE