Provider Demographics
NPI:1073038311
Name:ANDERSON, KRISTEN HELENE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HELENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 WOODGLEN LN #101
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4546
Mailing Address - Country:US
Mailing Address - Phone:630-607-9062
Mailing Address - Fax:
Practice Address - Street 1:616 DALHART AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1332
Practice Address - Country:US
Practice Address - Phone:815-866-4343
Practice Address - Fax:815-886-7299
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist