Provider Demographics
NPI:1255654265
Name:KRECKMAN HIETT, GLENNA V (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:V
Last Name:KRECKMAN HIETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:GLENNA
Other - Middle Name:V
Other - Last Name:KRECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:17498 N LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-4551
Mailing Address - Country:US
Mailing Address - Phone:217-826-3477
Mailing Address - Fax:773-326-0633
Practice Address - Street 1:17498 N LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-4551
Practice Address - Country:US
Practice Address - Phone:217-826-3477
Practice Address - Fax:773-326-0633
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000184101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional