Provider Demographics
NPI:1841866423
Name:KRISTIN BAILEY PLLC
Entity type:Organization
Organization Name:KRISTIN BAILEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PMH-C
Authorized Official - Phone:815-954-1548
Mailing Address - Street 1:201 PARK PL STE 11
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1883
Mailing Address - Country:US
Mailing Address - Phone:815-954-1548
Mailing Address - Fax:815-932-3663
Practice Address - Street 1:201 PARK PL STE 11
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1883
Practice Address - Country:US
Practice Address - Phone:815-954-1548
Practice Address - Fax:815-932-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)