Provider Demographics
NPI:1194298802
Name:PADILLA, CHRISTOPHER (MS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PADILLA
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KAUSRUD ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4717
Mailing Address - Country:US
Mailing Address - Phone:408-548-9577
Mailing Address - Fax:
Practice Address - Street 1:401 ROAD 7
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9614
Practice Address - Country:US
Practice Address - Phone:307-222-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12792390200000X
CA28872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program