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NPI Code Detail

MEDICARE: BRAD CHRISTENSEN

MEDICARE: BRAD CHRISTENSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21041C0700XClinical Social Worker9169380-3501UT

General Provider Information

NPI Number : 1124370440
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD CHRISTENSEN
Provider Business Mailing Address
First Line : 351 S GOSHEN ST
Second Line :
City : SALT LAKE CTY
State : UT
Zip : 84104-1217
Country : US
Telephone Number : 801-643-0004
Fax Number :
Provider Business Practice Location Address
First Line : 660 S 200 E STE 250
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-3846
Country : US
Telephone Number : 801-359-2256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2012
Last Update Date : 04/16/2025

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Directions to “ BRAD CHRISTENSEN ” Practice Location

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