Provider Demographics
NPI:1326179458
Name:MAAS, KJERSTINE J (MS)
Entity type:Individual
Prefix:
First Name:KJERSTINE
Middle Name:J
Last Name:MAAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:MINIER
Mailing Address - State:IL
Mailing Address - Zip Code:61759-0543
Mailing Address - Country:US
Mailing Address - Phone:309-305-4016
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR STE 1000
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7905
Practice Address - Country:US
Practice Address - Phone:309-663-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional