Provider Demographics
NPI:1205483658
Name:CHRISTENSEN, GRACE PRIMROSE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:PRIMROSE
Last Name:CHRISTENSEN
Suffix:
Gender:
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 1:13635 NW CORNELL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5885
Mailing Address - Country:US
Mailing Address - Phone:360-989-7347
Mailing Address - Fax:
Practice Address - Street 1:13635 NW CORNELL RD STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5885
Practice Address - Country:US
Practice Address - Phone:360-989-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60979070235Z00000X
OR016663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist