Healthcare Provider Details

I. General information

NPI: 1700298924
Provider Name (Legal Business Name): MARY CHRISTENSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W IRONWOOD DRIVE STE 102
COEUR D ALENE ID
83814-2785
US

IV. Provider business mailing address

212 W IRONWOOD DR SUITE D PMB 545
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-2486
  • Fax: 208-906-0818
Mailing address:
  • Phone: 208-664-2486
  • Fax: 208-906-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36902
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW 1513
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: