Provider Demographics
NPI:1487079802
Name:ANDERSON, CHRISTIE BURNETT (MA)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:BURNETT
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PARKVIEW DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3250
Mailing Address - Country:US
Mailing Address - Phone:208-733-0601
Mailing Address - Fax:
Practice Address - Street 1:221 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8436
Practice Address - Country:US
Practice Address - Phone:208-788-0296
Practice Address - Fax:208-788-9679
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2522231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist