Provider Demographics
NPI:1851444749
Name:CHRISTENSEN, JON ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:ROBERT
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2310 S GREENBAY RD
Mailing Address - Street 2:C-325
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4957
Mailing Address - Country:US
Mailing Address - Phone:414-530-6575
Mailing Address - Fax:414-761-4750
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:#411
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-530-6575
Practice Address - Fax:414-761-4750
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI272101YA0400X
WI1128125101YP2500X
WI2402120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI181549OtherTRICARE
WI39209600Medicaid