Provider Demographics
NPI:1770790578
Name:CHRISTENSON, COREY ALLEN (RN, BSW)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ALLEN
Last Name:CHRISTENSON
Suffix:
Gender:M
Credentials:RN, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E7911 ROGNSTAD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619-7143
Mailing Address - Country:US
Mailing Address - Phone:608-634-2067
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1992-120104100000X
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health