Provider Demographics
NPI:1427398734
Name:CHRISTENSEN, RONALD G (EDD; CADC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:EDD; CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3754
Mailing Address - Country:US
Mailing Address - Phone:309-757-0300
Mailing Address - Fax:309-757-0400
Practice Address - Street 1:111 19TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3754
Practice Address - Country:US
Practice Address - Phone:309-757-0300
Practice Address - Fax:309-757-0400
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)