Provider Demographics
NPI:1669071288
Name:WARDEN, KRISTIN SMITH (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SMITH
Last Name:WARDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2338
Mailing Address - Country:US
Mailing Address - Phone:847-274-8647
Mailing Address - Fax:
Practice Address - Street 1:566 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2338
Practice Address - Country:US
Practice Address - Phone:847-274-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health