Provider Demographics
NPI:1790867315
Name:CHRISTENSEN, KATHRYN MARIE (LP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 EDINBOROUGH WAY STE 370
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-6029
Mailing Address - Country:US
Mailing Address - Phone:612-309-3859
Mailing Address - Fax:952-303-3754
Practice Address - Street 1:3300 EDINBOROUGH WAY STE 370
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-6029
Practice Address - Country:US
Practice Address - Phone:612-309-3859
Practice Address - Fax:952-303-3754
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4679103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist