Provider Demographics
NPI:1992364053
Name:CHRISTOPHERSON, JOHN MICHAEL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 COUNTY ROAD 7 SW
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56343-8215
Mailing Address - Country:US
Mailing Address - Phone:320-808-0498
Mailing Address - Fax:
Practice Address - Street 1:507 N NOKOMIS ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2353
Practice Address - Country:US
Practice Address - Phone:320-219-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2848237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist