MEDICARE: IAN CHRISTENSEN LSW

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
1	1041C0700X	Clinical Social Worker	150.114544	IL
2	1041C0700X	Clinical Social Worker	149.041142	IL

General Provider Information

NPI Number	:	1396623906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN CHRISTENSEN LSW

Provider Business Mailing Address
First Line	:	1616 N DAMEN AVE STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 N DAMEN AVE STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5536
Country	:	US
Telephone Number	:	888-926-3251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	05/12/2026

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Directions to “ IAN CHRISTENSEN LSW” Practice Location

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