NPIMap

Individual provider Active NPI

Gary L Christianson, LCSW

  • Clinical Social Worker
  • Milwaukee, WI
National Provider Identifier
1164464905
Registry record updated Apr 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1762-123 Issued in WI
Practice address
3267 S 16TH St
Ohio Building - Room 209
Milwaukee, WI 53215-4500
Phone
(414) 389-3111
Fax
(414) 389-3110
NPI assigned
Jun 12, 2006
Last updated
Apr 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1762-123 WI Primary

Addresses

Primary practice location

3267 S 16TH St
Ohio Building - Room 209
Milwaukee, WI 53215-4500

Mailing address

3267 S 16TH St
Ohio Building - Room 209
Milwaukee, WI 53215-4500
Phone (414) 389-3111

Other identifiers 1

IdentifierTypeStateIssuer
39621700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1762WIMDClinical Neuropsychologist
1762-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Wheaton Franciscan Healthcare Past Accepting new patients
Ascension St Francis Hospital, Inc Past Accepting new patients
Ascension St Francis Hospital, Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1164464905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3267 S 16TH ST",
            "address_2": "OHIO BUILDING - ROOM 209",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154500",
            "telephone_number": "414-389-3111",
            "fax_number": "414-389-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3267 S 16TH ST",
            "address_2": "OHIO BUILDING - ROOM 209",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154500",
            "telephone_number": "414-389-3111",
            "fax_number": "414-389-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTIANSON",
        "first_name": "GARY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1762-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39621700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.