Provider Demographics
NPI:1700026820
Name:CHAE, KRISTIN JN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:JN
Last Name:CHAE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:J
Other - Last Name:NERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:4256 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1110
Mailing Address - Country:US
Mailing Address - Phone:312-880-9429
Mailing Address - Fax:
Practice Address - Street 1:4256 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1110
Practice Address - Country:US
Practice Address - Phone:312-880-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490134591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical