MEDICARE: DAWN ERIN CHRISTENSEN, PSYD, LLC

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

General Provider Information

NPI Number	:	1730311721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN ERIN CHRISTENSEN, PSYD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 625
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33836-0625
Country	:	US
Telephone Number	:	603-344-1819
Fax Number	:	863-353-6081

Provider Business Practice Location Address
First Line	:	410 LAKE DAVENPORT CIR
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7530
Country	:	US
Telephone Number	:	603-344-1819
Fax Number	:	863-353-6081

Authorized Official
Title or Position	:	PSYCHOLOGIST OWNER
Name	:	DR. DAWN ERIN CHRISTENSEN
Credential	:	PSYD
Telephone Number	:	603-344-1819

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	07/18/2012

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