Healthcare Provider Details

I. General information

NPI: 1902262165
Provider Name (Legal Business Name): KRISTEN SILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WALNUT ST
CHAMPAIGN IL
61820-3055
US

IV. Provider business mailing address

301 E CHALMERS ST APT 306
CHAMPAIGN IL
61820-9130
US

V. Phone/Fax

Practice location:
  • Phone: 217-373-2430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS41651493958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: