Provider Demographics
NPI:1164804944
Name:HAMPTON, KIRSTEN RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:RAE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7164
Mailing Address - Country:US
Mailing Address - Phone:309-428-5939
Mailing Address - Fax:
Practice Address - Street 1:4000 46TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7164
Practice Address - Country:US
Practice Address - Phone:309-428-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker