Provider Demographics
NPI:1639494610
Name:POLLEY, KRISTINA E (LCSW,RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:E
Last Name:POLLEY
Suffix:
Gender:F
Credentials:LCSW,RN
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:P
Other - Last Name:SLONIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,RN
Mailing Address - Street 1:13423 DEARBORN TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7816
Mailing Address - Country:US
Mailing Address - Phone:847-710-1800
Mailing Address - Fax:847-659-9661
Practice Address - Street 1:13423 DEARBORN TRL
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7816
Practice Address - Country:US
Practice Address - Phone:847-710-1800
Practice Address - Fax:847-659-9661
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0062051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical