Provider Demographics
NPI:1205384468
Name:BLASBERG, KRISANNA SHARON (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISANNA
Middle Name:SHARON
Last Name:BLASBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISANNA
Other - Middle Name:MARIE
Other - Last Name:SHARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-0140
Mailing Address - Country:US
Mailing Address - Phone:630-755-5300
Mailing Address - Fax:331-236-0370
Practice Address - Street 1:2135 CITYGATE LN
Practice Address - Street 2:STE. 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3066
Practice Address - Country:US
Practice Address - Phone:630-755-5300
Practice Address - Fax:331-236-0370
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103T00000X
IL071.011194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist