Basic Information
| Provider Information | |||||||||
| NPI: | 1285639807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | BRANT | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21804 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820037073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264327 | ||||||||
| FaxNumber: | 3074263277 | ||||||||
| Practice Location | |||||||||
| Address1: | 7215 COMMONS CIR UNIT C | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264327 | ||||||||
| FaxNumber: | 3074263277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231HA2400X | A963 | WY | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | A963 | WY | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | A963 | WY | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | A-963 | WY | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 112860402 | 05 | WY | MEDICAID |