Healthcare Provider Details

I. General information

NPI: 1992293625
Provider Name (Legal Business Name): JESSICA ANN CHRISTENSEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 VICTOR PATH STE 900
HUGO MN
55038-4732
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 651-364-3839
  • Fax:
Mailing address:
  • Phone: 612-464-6671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32703
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number600107010303610
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: