Provider Demographics
NPI:1841392834
Name:CHRISTENSEN, MARTHA ANN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62199 199TH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-6407
Mailing Address - Country:US
Mailing Address - Phone:320-693-6397
Mailing Address - Fax:
Practice Address - Street 1:513 5TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3216
Practice Address - Country:US
Practice Address - Phone:320-214-9692
Practice Address - Fax:320-214-9924
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN05Q59CHOtherBLUE CROSS/BLUE SHIELD