Provider Demographics
NPI:1841665106
Name:KNIGHT, KIRSTEN OLIVIA (LCPC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:OLIVIA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 S ROUTE 59 STE 201
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2788
Mailing Address - Country:US
Mailing Address - Phone:630-881-6840
Mailing Address - Fax:
Practice Address - Street 1:15130 S ROUTE 59 STE 201
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2788
Practice Address - Country:US
Practice Address - Phone:630-881-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011549101YP2500X
IL180.011463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.011463OtherLICENSE NUMBER