Healthcare Provider Details

I. General information

NPI: 1881683688
Provider Name (Legal Business Name): CHRISTOFFERSON CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 4TH ST NE STE 11
DEVILS LAKE ND
58301-2576
US

IV. Provider business mailing address

512 4TH ST NE STE 11
DEVILS LAKE ND
58301-2576
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-3030
  • Fax: 701-665-3366
Mailing address:
  • Phone: 701-665-3030
  • Fax: 701-665-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number332
License Number StateND

VIII. Authorized Official

Name: MS. SANDI C CHRISTOFFERSON
Title or Position: OWNER INDEPENDENT PRACTITIONER
Credential: LICSW
Phone: 701-665-3030