Provider Demographics
NPI:1215079231
Name:CHRISTIANS, AUDREY LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LEIGH
Last Name:CHRISTIANS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:LEIGH
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6973 W AIRE LIBRE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3987
Mailing Address - Country:US
Mailing Address - Phone:623-466-7471
Mailing Address - Fax:623-466-7471
Practice Address - Street 1:17999 W. SURPRISE FARMS LOOP SOUTH
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388
Practice Address - Country:US
Practice Address - Phone:623-876-7350
Practice Address - Fax:623-876-7361
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ811100Medicaid