Provider Demographics
NPI:1427423474
Name:DRAUGHAN, KRISTEN JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:DRAUGHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:JEAN
Other - Last Name:DRAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17385 N 1100TH RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-8839
Mailing Address - Country:US
Mailing Address - Phone:309-344-4362
Mailing Address - Fax:309-344-4281
Practice Address - Street 1:1601 W JACKSON ST STE 104
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-1901
Practice Address - Country:US
Practice Address - Phone:309-575-3222
Practice Address - Fax:309-404-8000
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0203201041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370984175Medicaid
IL655630Medicare UPIN