Provider Demographics
NPI:1225139827
Name:CHRISTENSEN, KELLEY J (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:J
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-5800
Mailing Address - Country:US
Mailing Address - Phone:605-987-2621
Mailing Address - Fax:605-987-5631
Practice Address - Street 1:440 N HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-5800
Practice Address - Country:US
Practice Address - Phone:605-987-2621
Practice Address - Fax:605-987-5631
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD19081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575692Medicaid
SD6575692Medicaid