Provider Demographics
NPI:1972802692
Name:GONYON, KRISTINE (MA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:GONYON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N SACRAMENTO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1046
Mailing Address - Country:US
Mailing Address - Phone:773-318-7454
Mailing Address - Fax:
Practice Address - Street 1:700 N SACRAMENTO BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1046
Practice Address - Country:US
Practice Address - Phone:773-318-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health