Provider Demographics
NPI:1104607860
Name:SIMPSON, CHRISTINE ROSE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROSE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 WESTWIND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-0653
Mailing Address - Country:US
Mailing Address - Phone:320-492-4329
Mailing Address - Fax:
Practice Address - Street 1:228 KRAYS MILL RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-4563
Practice Address - Country:US
Practice Address - Phone:320-348-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst