Provider Demographics
NPI:1841446358
Name:PROBST, KRISTI M (MS)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:M
Last Name:PROBST
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 1:3142 BUTTERFLY DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9397
Mailing Address - Country:US
Mailing Address - Phone:309-454-4925
Mailing Address - Fax:
Practice Address - Street 1:3142 BUTTERFLY DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-9397
Practice Address - Country:US
Practice Address - Phone:309-454-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2150695222Q00000X
IL2150694222Q00000X
IL2150697222Q00000X
IL2150696222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist