Provider Demographics
NPI:1316963457
Name:MARE, CHRISTINE L (AUD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:MARE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:L
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:6555 N CAMINO ARTURO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2013
Mailing Address - Country:US
Mailing Address - Phone:520-797-4780
Mailing Address - Fax:520-797-4780
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:5-126
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-629-1846
Practice Address - Fax:520-629-4707
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1309231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ372475Medicaid
S37060Medicare UPIN
AU1085582Medicare ID - Type Unspecified