Provider Demographics
NPI:1881007532
Name:KRYSTYNIAK, KATY
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:KRYSTYNIAK
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 1:5801 NORTH PULASKI ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:312-744-1906
Mailing Address - Fax:312-744-5568
Practice Address - Street 1:5801 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6007
Practice Address - Country:US
Practice Address - Phone:312-744-1906
Practice Address - Fax:312-744-5568
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor