Provider Demographics
NPI:1376917609
Name:CHRISTENSEN, KJARSTEN (CSW)
Entity Type:Individual
Prefix:
First Name:KJARSTEN
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2135
Mailing Address - Country:US
Mailing Address - Phone:801-652-7595
Mailing Address - Fax:
Practice Address - Street 1:1555 W 2200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1429
Practice Address - Country:US
Practice Address - Phone:801-886-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT944882635021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical