Provider Demographics
NPI:1689773616
Name:CHRISTOPHERSON, KAREN ANN (MSW, LMSW, CAADC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:MSW, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 CASCADE ROAD SE
Mailing Address - Street 2:STE. 2B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-450-5628
Mailing Address - Fax:616-459-4959
Practice Address - Street 1:4519 CASCADE ROAD SE
Practice Address - Street 2:STE. 2B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-450-5628
Practice Address - Fax:616-954-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801006046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD16262034Medicare ID - Type Unspecified
MIMI5107Medicare UPIN