Provider Demographics
NPI:1407330483
Name:HEIDER, KRISTIN L (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:HEIDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1863
Mailing Address - Country:US
Mailing Address - Phone:847-304-0780
Mailing Address - Fax:
Practice Address - Street 1:901 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1863
Practice Address - Country:US
Practice Address - Phone:847-304-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011066103TC0700X
IA089117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist