Provider Demographics
NPI:1942697545
Name:STIVEN, CHRISTINE (LSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:STIVEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HODOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:524 4TH AVE NE
Mailing Address - Street 2:UNIT 19
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2490
Mailing Address - Country:US
Mailing Address - Phone:701-662-7050
Mailing Address - Fax:701-662-3360
Practice Address - Street 1:524 4TH AVE NE
Practice Address - Street 2:UNIT 19
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2490
Practice Address - Country:US
Practice Address - Phone:701-662-7050
Practice Address - Fax:701-662-3360
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3420104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND79106Medicaid