Provider Demographics
NPI:1720584717
Name:MOROZ, KRISTYN
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:MOROZ
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 1:1775 CHADWICKE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0398
Mailing Address - Country:US
Mailing Address - Phone:630-854-4280
Mailing Address - Fax:
Practice Address - Street 1:1811 W DIEHL RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9086
Practice Address - Country:US
Practice Address - Phone:630-428-1595
Practice Address - Fax:630-428-8772
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-28703103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst