Basic Information
| Provider Information | |||||||||
| NPI: | 1184026619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 N 4TH W APT 3 | ||||||||
| Address2: | |||||||||
| City: | RIGBY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834425032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089914296 | ||||||||
| FaxNumber: | 2082611922 | ||||||||
| Practice Location | |||||||||
| Address1: | 2635 CHANNING WAY STE B | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085520490 | ||||||||
| FaxNumber: | 2085522518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-36853 | ID | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LMSW-33840 | ID | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.