Provider Demographics
NPI:1952533028
Name:FUNASAKI-FIENE, KRISTYN SAKIKO (PHD)
Entity Type:Individual
Prefix:MS
First Name:KRISTYN
Middle Name:SAKIKO
Last Name:FUNASAKI-FIENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:SAKIKO
Other - Last Name:FUNASAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:2285 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-859-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical