Provider Demographics
NPI:1710479803
Name:PRAZNOWSKI, KRISTIN MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARY
Last Name:PRAZNOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARY
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6339 N NOKOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4128
Mailing Address - Country:US
Mailing Address - Phone:203-623-2348
Mailing Address - Fax:
Practice Address - Street 1:6339 N NOKOMIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4128
Practice Address - Country:US
Practice Address - Phone:203-623-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490202911041C0700X
IL149.0202911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty