=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215079231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY LEIGH CHRISTIANS M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17999 W. SURPRISE FARMS LOOP SOUTH
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-876-7350
-----------------------------------------------------
Fax | 623-876-7361
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6973 W AIRE LIBRE AVE
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85382-3987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-466-7471
-----------------------------------------------------
Fax | 623-466-7471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP0799
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------