Healthcare Provider Details

I. General information

NPI: 1699752733
Provider Name (Legal Business Name): SUSAN CHRISTENSEN, LCSW, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 W 300 S
OREM UT
84058-5395
US

IV. Provider business mailing address

PO BOX 2185
OREM UT
84059-2185
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-8862
  • Fax: 801-225-7310
Mailing address:
  • Phone: 801-426-8862
  • Fax: 801-225-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129634-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SUSAN SNOW CHRISTENSEN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW, RPT-S
Phone: 801-426-8862