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NPI Code Detail

MEDICARE: MRS. TAMARA B CHRISTENSON LICSW

MEDICARE: MRS. TAMARA B CHRISTENSON LICSW
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
11041C0700XClinical Social Worker13897MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1524G3CHOTHERMNBCBSMN
231002005OTHERMNPRIME WEST
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
456308-A003OTHERMNTRIWEST
5138661OTHERMNUCARE
6990991049165OTHERMNBHP PREFERRED 1

General Provider Information

NPI Number : 1134348949
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMARA B CHRISTENSON LICSW
Provider Business Mailing Address
First Line : 5476 MUD LAKE LN SW
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-6304
Country : US
Telephone Number : 320-763-9612
Fax Number : 320-762-0796
Provider Business Practice Location Address
First Line : 324 BROADWAY ST STE 206
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-1482
Country : US
Telephone Number : 320-762-1762
Fax Number : 320-762-0796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 04/05/2012

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