Provider Demographics
NPI:1518582824
Name:ESCAMILLO, KRISTA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:ESCAMILLO
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 1:301 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2899
Mailing Address - Country:US
Mailing Address - Phone:815-954-0022
Mailing Address - Fax:
Practice Address - Street 1:301 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2899
Practice Address - Country:US
Practice Address - Phone:815-954-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist