Provider Demographics
NPI:1407156904
Name:WEEKS, KRISTIN ELISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELISE
Last Name:WEEKS
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 1:918 GLASGOW LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1904
Mailing Address - Country:US
Mailing Address - Phone:815-459-1682
Mailing Address - Fax:
Practice Address - Street 1:918 GLASGOW LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1904
Practice Address - Country:US
Practice Address - Phone:815-459-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical