Basic Information
| Provider Information | |||||||||
| NPI: | 1689773616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTOPHERSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LMSW, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4519 CASCADE ROAD SE | ||||||||
| Address2: | STE. 2B | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164505628 | ||||||||
| FaxNumber: | 6164594959 | ||||||||
| Practice Location | |||||||||
| Address1: | 4519 CASCADE ROAD SE | ||||||||
| Address2: | STE. 2B | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164505628 | ||||||||
| FaxNumber: | 6169541998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 11/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801006046 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.