Christianson, Gary L

Christianson, Gary L is an individual health care provider with primary practice located at 3267 S 16Th St Ohio Building - Room 209, Milwaukee WI 53215-4500. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Christianson, Gary L can be contacted via phone (414) 389-3111.

Contact Information

Primary practice address
3267 S 16Th St Ohio Building - Room 209 Milwaukee WI 53215-4500
Phone: (414) 389-3111
Fax: (414) 389-3110
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1762-123 Wisconsin

Profile Details

NPI number 1164464905
LBN Legal business name Christianson, Gary L
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2006
Last updated Apr 18th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164464905 NPPES
Wisconsin MEDICAID 39621700

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