Provider Demographics
NPI:1356323620
Name:GRACE, KRISTIN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:GRACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 N KIMBALL AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3726
Mailing Address - Country:US
Mailing Address - Phone:312-259-8008
Mailing Address - Fax:
Practice Address - Street 1:1936 N KIMBALL AVE
Practice Address - Street 2:APT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3726
Practice Address - Country:US
Practice Address - Phone:312-259-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0114271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical