Provider Demographics
NPI:1285890053
Name:MORTENSON, CHRISTIAN PAUL (MSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:PAUL
Last Name:MORTENSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5227
Mailing Address - Country:US
Mailing Address - Phone:907-561-0954
Mailing Address - Fax:907-561-7093
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-561-0954
Practice Address - Fax:907-561-7093
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical