Provider Demographics
NPI:1437682242
Name:CHRISTENSEN, AMY (LADC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7846 ALDEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2406
Mailing Address - Country:US
Mailing Address - Phone:612-916-4874
Mailing Address - Fax:
Practice Address - Street 1:7846 ALDEN WAY NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2406
Practice Address - Country:US
Practice Address - Phone:612-916-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30145101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)