Provider Demographics
NPI:1114323359
Name:PADERA, KRISTIN (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PADERA
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:GEORGIANNE
Other - Last Name:PADERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:1131 WHEATON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3181
Mailing Address - Country:US
Mailing Address - Phone:630-940-6828
Mailing Address - Fax:
Practice Address - Street 1:1131 WHEATON OAKS CT
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3181
Practice Address - Country:US
Practice Address - Phone:630-940-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.010203OtherLICENSE NUMBER