Provider Demographics
NPI:1598938151
Name:CHRISTIANSON, DONNA (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4918
Mailing Address - Country:US
Mailing Address - Phone:608-792-7700
Mailing Address - Fax:
Practice Address - Street 1:1504 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4918
Practice Address - Country:US
Practice Address - Phone:608-792-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12831231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39287600Medicaid