Provider Demographics
NPI:1023577046
Name:GEARY, KRISTIN BRIANNE (EDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BRIANNE
Last Name:GEARY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N CROSSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2091
Mailing Address - Country:US
Mailing Address - Phone:158-933-3371
Mailing Address - Fax:
Practice Address - Street 1:111 N CROSSWELL AVE
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2091
Practice Address - Country:US
Practice Address - Phone:158-933-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool