Provider Demographics
NPI:1356539753
Name:KINDL-VALDEZ, KARRIE LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KARRIE
Middle Name:LYNN
Last Name:KINDL-VALDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KARRIE
Other - Middle Name:LYNN
Other - Last Name:KINDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4007 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2110
Mailing Address - Country:US
Mailing Address - Phone:773-537-2569
Mailing Address - Fax:773-305-1101
Practice Address - Street 1:4007 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2110
Practice Address - Country:US
Practice Address - Phone:773-537-2569
Practice Address - Fax:773-305-1101
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490116961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.011696OtherBLUE SHIELD