Provider Demographics
NPI:1730647090
Name:KRC, MICHELLE A (LCSW, MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:KRC
Suffix:
Gender:F
Credentials:LCSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 FENIMORE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7377
Mailing Address - Country:US
Mailing Address - Phone:247-159-6302
Mailing Address - Fax:
Practice Address - Street 1:210 CRYSTAL ST STE C
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2096
Practice Address - Country:US
Practice Address - Phone:224-338-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102806104100000X
IL149.0213741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker