Provider Demographics
NPI:1497957930
Name:BREESE, KRISTEN A (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:BREESE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5447
Mailing Address - Country:US
Mailing Address - Phone:630-476-1785
Mailing Address - Fax:
Practice Address - Street 1:1979 N MILL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1200
Practice Address - Country:US
Practice Address - Phone:630-281-2496
Practice Address - Fax:630-839-9138
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional