Provider Demographics
NPI:1891837498
Name:CALLISON, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CALLISON
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 1:16045 APPLEWOOD LN
Mailing Address - Street 2:303
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7481
Mailing Address - Country:US
Mailing Address - Phone:765-748-6512
Mailing Address - Fax:
Practice Address - Street 1:19065 HICKORY CREEK PL
Practice Address - Street 2:110
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8507
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist