Provider Demographics
NPI:1093142507
Name:SUNDERMANN, KRISTINA M (MAAT, LCPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:SUNDERMANN
Suffix:
Gender:F
Credentials:MAAT, LCPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2342
Mailing Address - Country:US
Mailing Address - Phone:773-354-6787
Mailing Address - Fax:
Practice Address - Street 1:522 W BURLINGTON AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:773-354-6787
Practice Address - Fax:630-468-2865
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional