Provider Demographics
NPI:1477916575
Name:CHRISTENSEN, CYNTHIA (SSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 W 12700 S
Mailing Address - Street 2:STE. D
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1262 W 12700 S
Practice Address - Street 2:STE. D
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7798
Practice Address - Country:US
Practice Address - Phone:385-468-4610
Practice Address - Fax:385-468-4611
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7855735-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker