Provider Demographics
NPI:1003440769
Name:REFVIK, KIRSTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:REFVIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 JILL LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1146
Mailing Address - Country:US
Mailing Address - Phone:336-420-3367
Mailing Address - Fax:
Practice Address - Street 1:105 JILL LN
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1146
Practice Address - Country:US
Practice Address - Phone:336-420-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490151031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical