Provider Demographics
NPI:1720076565
Name:CHRISTENSEN, LISA K (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 S. ADAMS AVE. PKWY.
Mailing Address - Street 2:B
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6748
Mailing Address - Country:US
Mailing Address - Phone:801-394-4399
Mailing Address - Fax:801-394-5003
Practice Address - Street 1:5275 S. ADAMS AVE. PKWY.
Practice Address - Street 2:B
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6748
Practice Address - Country:US
Practice Address - Phone:801-394-4399
Practice Address - Fax:801-394-5003
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT336324-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07400Medicare UPIN
UT000011892Medicare ID - Type UnspecifiedPROVIDER ID