Provider Demographics
NPI:1265789481
Name:FEDERLEIN, KRISTEN ANNE (LCPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:FEDERLEIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 MCDOWELL ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-689-1022
Mailing Address - Fax:630-689-1023
Practice Address - Street 1:1952 MCDOWELL ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-689-1022
Practice Address - Fax:630-689-1023
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health