Provider Demographics
NPI:1942235262
Name:CHRISTIANSON, PENELOPE (MDIV PSYD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:MDIV PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 SE BENTLEY STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-615-8010
Mailing Address - Fax:503-615-8010
Practice Address - Street 1:1817 NE 17TH AVENUE
Practice Address - Street 2:SAMARITAN COUNSELING CENTERS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212
Practice Address - Country:US
Practice Address - Phone:503-281-3318
Practice Address - Fax:503-281-0937
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271177Medicaid
OR271177Medicaid