Provider Demographics
NPI:1871349720
Name:CHRISTENSEN, JAYEDEN (CMT)
Entity type:Individual
Prefix:
First Name:JAYEDEN
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5183 E EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4449
Mailing Address - Country:US
Mailing Address - Phone:320-441-9986
Mailing Address - Fax:
Practice Address - Street 1:5183 E EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4449
Practice Address - Country:US
Practice Address - Phone:320-441-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist