MEDICARE: KRISTINA L MENZEL LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180001135	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	215708	OTHER	COM PSYCH
2	623783	OTHER	BCBS ILL
3	20206303403	OTHER	JOHN DEERE
4	361563452	OTHER	TRICARE

General Provider Information

NPI Number	:	1952373243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA L MENZEL LCPC

Provider Business Mailing Address
First Line	:	1717 FLETCHER ST
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-2609
Country	:	US
Telephone Number	:	815-878-3926
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 PARK AVE E
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-3901
Country	:	US
Telephone Number	:	815-876-2004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	09/21/2021

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Directions to “ KRISTINA L MENZEL LCPC” Practice Location

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