Provider Demographics
NPI:1790189157
Name:WHITEFORD, KRISTEN (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WHITEFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 CHICKASAW DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-0535
Mailing Address - Country:US
Mailing Address - Phone:847-370-9031
Mailing Address - Fax:
Practice Address - Street 1:5175 CHICKASAW DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-0535
Practice Address - Country:US
Practice Address - Phone:847-370-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst