Provider Demographics
NPI:1477876795
Name:KOHLER, KRISTY MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MARIE
Last Name:KOHLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4144 N SHERIDAN RD
Mailing Address - Street 2:#611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2058
Mailing Address - Country:US
Mailing Address - Phone:312-513-1898
Mailing Address - Fax:312-254-1390
Practice Address - Street 1:325 N WELLS ST
Practice Address - Street 2:#527
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7024
Practice Address - Country:US
Practice Address - Phone:312-467-2318
Practice Address - Fax:312-254-1390
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical