Provider Demographics
NPI:1396453122
Name:CHRISTENSEN, GRACE ANN (APSW, SAC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:APSW, SAC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:FEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5643 W WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8438
Mailing Address - Country:US
Mailing Address - Phone:920-404-2100
Mailing Address - Fax:
Practice Address - Street 1:5643 W WATERFORD LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8438
Practice Address - Country:US
Practice Address - Phone:920-404-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134877-121104100000X
WI19648-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker