Individual
REGINALD C CHRISTIANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCIII LADC
Contact information
Practice address
412 W KINNE ST, ELLSWORTH, WI 54011
(715) 273-6770
(715) 273-6770
Mailing address
PO BOX 670, ELLSWORTH, WI 54011-0670
(715) 273-6770
(715) 273-6862
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
301067
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
812
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39345400
—
WI
01
—
5H765CH
BLUECROSS BLUESHIELD
MN
01
—
920461021641
PREFERRED ONE
MN
Enumeration date
11/15/2006
Last updated
07/09/2007
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