Provider Demographics
NPI:1407310659
Name:HUFFMAN-GOTTSCHLING, KRISTEN SUZANNE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:HUFFMAN-GOTTSCHLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 N GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2628
Mailing Address - Country:US
Mailing Address - Phone:773-338-9102
Mailing Address - Fax:773-338-9103
Practice Address - Street 1:7101 N GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2628
Practice Address - Country:US
Practice Address - Phone:773-338-9102
Practice Address - Fax:773-338-9103
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker