Healthcare Provider Details

I. General information

NPI: 1215871397
Provider Name (Legal Business Name): JACOB CHRISTENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

IV. Provider business mailing address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-1797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5522
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: