Provider Demographics
NPI:1699079061
Name:RUDDY, CHRISTIE MARI (AUD/ CCC-A)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARI
Last Name:RUDDY
Suffix:
Gender:F
Credentials:AUD/ CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 E 16TH AVE
Mailing Address - Street 2:B030
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7106
Mailing Address - Country:US
Mailing Address - Phone:720-478-0160
Mailing Address - Fax:720-478-7026
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B030
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-478-0160
Practice Address - Fax:720-478-7026
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO288231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43055834Medicaid