Provider Demographics
NPI:1043885593
Name:CHRISTIANSEN, AMY JEAN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2302
Mailing Address - Country:US
Mailing Address - Phone:612-242-7170
Mailing Address - Fax:
Practice Address - Street 1:CARAVELE AUTISM HEALTH
Practice Address - Street 2:3007 HARBOR LANE NORTH
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:612-439-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician