MEDICARE: MS. JENNIFER LYNN CHRISTESON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2431057	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437146222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN CHRISTESON PHD

Provider Business Mailing Address
First Line	:	416 W SOUTH ST
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-2755
Country	:	US
Telephone Number	:	262-567-7673
Fax Number	:	262-567-3097

Provider Business Practice Location Address
First Line	:	6944 W FOREST HOME AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-2917
Country	:	US
Telephone Number	:	262-719-3824
Fax Number	:	414-321-8588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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