Provider Demographics
NPI:1346849015
Name:CHRISTENSEN, STACY JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:JEAN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 GRAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3492
Mailing Address - Country:US
Mailing Address - Phone:612-454-1656
Mailing Address - Fax:651-560-3768
Practice Address - Street 1:658 GRAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3492
Practice Address - Country:US
Practice Address - Phone:612-454-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist