Provider Demographics
NPI:1548762677
Name:SMITH, KRISTEN N
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E LAKE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1100
Mailing Address - Country:US
Mailing Address - Phone:224-255-5150
Mailing Address - Fax:
Practice Address - Street 1:123 E LAKE ST
Practice Address - Street 2:STE 203
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1100
Practice Address - Country:US
Practice Address - Phone:847-946-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health