Provider Demographics
NPI:1508302712
Name:PERSON, KRISTLE (MED)
Entity Type:Individual
Prefix:
First Name:KRISTLE
Middle Name:
Last Name:PERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3830
Mailing Address - Country:US
Mailing Address - Phone:773-559-3403
Mailing Address - Fax:
Practice Address - Street 1:9119 S MERRILL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3830
Practice Address - Country:US
Practice Address - Phone:773-559-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist