Provider Demographics
NPI:1982119954
Name:CHRISTENSON, JEFFRY MILTON (LADC)
Entity type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:MILTON
Last Name:CHRISTENSON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2127
Mailing Address - Country:US
Mailing Address - Phone:218-739-9084
Mailing Address - Fax:218-739-0518
Practice Address - Street 1:217 N UNION AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2127
Practice Address - Country:US
Practice Address - Phone:218-739-9084
Practice Address - Fax:218-739-0518
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)