Provider Demographics
NPI:1225551732
Name:HERNANDEZ, KRISTIEN ARIEL
Entity Type:Individual
Prefix:MRS
First Name:KRISTIEN
Middle Name:ARIEL
Last Name:HERNANDEZ
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 1:2216 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2211
Mailing Address - Country:US
Mailing Address - Phone:708-705-0920
Mailing Address - Fax:
Practice Address - Street 1:2216 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2211
Practice Address - Country:US
Practice Address - Phone:708-705-0920
Practice Address - Fax:708-705-0920
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist