MEDICARE: MRS. JENNIFER LYNN CHRISTENSEN B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SLPA6943	AZ

General Provider Information

NPI Number	:	1669605531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN CHRISTENSEN B.A.

Provider Business Mailing Address
First Line	:	3411 N 16TH ST
Second Line	:	APT. 1055
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7150
Country	:	US
Telephone Number	:	765-271-3974
Fax Number	:

Provider Business Practice Location Address
First Line	:	21624 E VIA DEL RANCHO
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5362
Country	:	US
Telephone Number	:	480-677-3349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	11/22/2010

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