Provider Demographics
NPI:1548301039
Name:HARRISON, CHRISTINE S (LISW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:S
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:SUE
Other - Last Name:CARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-3200
Mailing Address - Fax:309-779-2755
Practice Address - Street 1:4622 PROGRESS DR STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3426
Practice Address - Country:US
Practice Address - Phone:563-742-5800
Practice Address - Fax:563-742-5810
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1548301039Medicaid
IA1548301039Medicaid