Provider Demographics
NPI:1912145996
Name:CHRISTENSEN, TERI LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:TERI
Middle Name:LYNN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4007
Mailing Address - Country:US
Mailing Address - Phone:920-336-0111
Mailing Address - Fax:
Practice Address - Street 1:600 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3503
Practice Address - Country:US
Practice Address - Phone:920-432-3213
Practice Address - Fax:920-432-0614
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2976-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist