Provider Demographics
NPI:1609809557
Name:CHRISTENSEN, JON ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ERIC
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7528
Mailing Address - Country:US
Mailing Address - Phone:509-255-6148
Mailing Address - Fax:
Practice Address - Street 1:905 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1016
Practice Address - Country:US
Practice Address - Phone:509-747-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical