Provider Demographics
NPI:1588858187
Name:LEPAGE, CHRISTOPHER A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:LEPAGE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MAIN ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5054
Mailing Address - Country:US
Mailing Address - Phone:651-383-6993
Mailing Address - Fax:651-342-0914
Practice Address - Street 1:333 MAIN ST N STE 204
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5054
Practice Address - Country:US
Practice Address - Phone:651-383-6993
Practice Address - Fax:651-342-0914
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23694103G00000X
WI2853-057103G00000X
MN6160103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist