Provider Demographics
NPI:1972280154
Name:MAGNUSEN, CHRISTOPHER JEREMY (SUDP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JEREMY
Last Name:MAGNUSEN
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 E 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4621
Mailing Address - Country:US
Mailing Address - Phone:509-279-5461
Mailing Address - Fax:
Practice Address - Street 1:701 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-6014
Practice Address - Country:US
Practice Address - Phone:509-838-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61448661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)