Provider Demographics
NPI:1730431289
Name:CHRISTENSEN, CIARA (PHD)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 N PROSPECT AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6333
Mailing Address - Country:US
Mailing Address - Phone:509-432-1142
Mailing Address - Fax:
Practice Address - Street 1:2266 N PROSPECT AVE STE 430
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6333
Practice Address - Country:US
Practice Address - Phone:509-432-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3622-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical