Provider Demographics
NPI:1558417782
Name:CHRISTIANSON, MARY BRIGID (LISW, RPT-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BRIGID
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LISW, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-424-7068
Mailing Address - Fax:641-423-3836
Practice Address - Street 1:9 2ND ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-424-7068
Practice Address - Fax:641-423-3836
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical