Provider Demographics
NPI:1134494594
Name:WATERFIELD, KRISTIN L (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:WATERFIELD
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WASHINGTON ST APT 206
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5684
Mailing Address - Country:US
Mailing Address - Phone:630-862-5715
Mailing Address - Fax:
Practice Address - Street 1:11000 US HIGHWAY 34 # 103
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-9824
Practice Address - Country:US
Practice Address - Phone:847-457-6730
Practice Address - Fax:847-485-5617
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional