Basic Information
Provider Information
NPI: 1053441394
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: LOUIS
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: BC-HIS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8800 SE SUNNYSIDE RD STE 300N
Address2:  
City: CLACKAMAS
State: OR
PostalCode: 970155703
CountryCode: US
TelephoneNumber: 2812862999
FaxNumber: 5126074893
Practice Location
Address1: 3229 BROADWAY ST
Address2: SUITE F
City: NORTH BEND
State: OR
PostalCode: 974592203
CountryCode: US
TelephoneNumber: 5417568944
FaxNumber: 5418080967
Other Information
ProviderEnumerationDate: 03/06/2007
LastUpdateDate: 01/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237600000X ORN Speech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter 
237700000XHAS-P-022240ORY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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