Provider Demographics
NPI:1922244805
Name:WALLACE, CHRISTINE D (AUD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:WALLACE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:D
Other - Last Name:SCHMELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-1100
Mailing Address - Country:US
Mailing Address - Phone:208-489-4690
Mailing Address - Fax:208-489-4072
Practice Address - Street 1:172 2ND ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3708
Practice Address - Country:US
Practice Address - Phone:208-385-3620
Practice Address - Fax:208-386-3621
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1246231H00000X
OR21617237600000X
IDAUD1246231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter