Provider Demographics
NPI:1922858620
Name:LASKER, KRISTINA L
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:LASKER
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 1:4638 N KELSO AVE UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4872
Mailing Address - Country:US
Mailing Address - Phone:765-586-4944
Mailing Address - Fax:
Practice Address - Street 1:126 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2014
Practice Address - Country:US
Practice Address - Phone:312-787-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health