Healthcare Provider Details

I. General information

NPI: 1902723505
Provider Name (Legal Business Name): CANDICE CHRISTENSEN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4073 DALE DR
LAFAYETTE CO
80026-9664
US

IV. Provider business mailing address

4073 DALE DR
LAFAYETTE CO
80026-9664
US

V. Phone/Fax

Practice location:
  • Phone: 406-478-0595
  • Fax:
Mailing address:
  • Phone: 406-478-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-SP-LIC-9697
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0006540
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: