Individual
MATTHEW A CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
1501 6TH ST, LA GRANDE, OR 97850-2419
(541) 962-0162
Mailing address
1101 I AVE, LA GRANDE, OR 97850-2043
(541) 962-0162
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000004201
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000004201
THW NUMBER
OR
Enumeration date
05/13/2020
Last updated
05/13/2020
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