Provider Demographics
NPI:1306400981
Name:BUELOW, KRISTINE (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BUELOW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W ROOSEVELT RD STE C2
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2306
Mailing Address - Country:US
Mailing Address - Phone:630-480-4118
Mailing Address - Fax:
Practice Address - Street 1:620 W ROOSEVELT RD STE C2
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2306
Practice Address - Country:US
Practice Address - Phone:630-480-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.101703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional