Provider Demographics
NPI:1821511270
Name:BROSCH, KRISTEN LEIGH (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:BROSCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W ROHMANN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4842
Mailing Address - Country:US
Mailing Address - Phone:309-671-0300
Mailing Address - Fax:
Practice Address - Street 1:3000 W ROHMANN AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4842
Practice Address - Country:US
Practice Address - Phone:309-671-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5933-125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker