Provider Demographics
NPI:1295862183
Name:ARDITTI, KRISTY LYNN (LCSW, CDVP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:ARDITTI
Suffix:
Gender:F
Credentials:LCSW, CDVP
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:REINECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1740 RIDGE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5918
Mailing Address - Country:US
Mailing Address - Phone:847-475-7003
Mailing Address - Fax:847-475-7333
Practice Address - Street 1:1740 RIDGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5918
Practice Address - Country:US
Practice Address - Phone:847-475-7003
Practice Address - Fax:847-475-7333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490136481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical