Healthcare Provider Details

I. General information

NPI: 1043120686
Provider Name (Legal Business Name): KIRSTYN TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S COUNTRY FAIR DR STE 2A
CHAMPAIGN IL
61821-3637
US

IV. Provider business mailing address

503 S COUNTRY FAIR DR STE 2A
CHAMPAIGN IL
61821-3637
US

V. Phone/Fax

Practice location:
  • Phone: 217-530-4040
  • Fax: 217-607-0498
Mailing address:
  • Phone: 217-530-4040
  • Fax: 217-607-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: