Provider Demographics
NPI:1376113415
Name:ENGLUND, KRISTIN V (MA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:V
Last Name:ENGLUND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 N KEDZIE AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5225
Mailing Address - Country:US
Mailing Address - Phone:269-325-6949
Mailing Address - Fax:
Practice Address - Street 1:3711 N RAVENSWOOD AVE STE 146
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5944
Practice Address - Country:US
Practice Address - Phone:773-274-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor