Healthcare Provider Details

I. General information

NPI: 1427466069
Provider Name (Legal Business Name): KRISTINA ANNERINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 S TALMAN AVE
CHICAGO IL
60655-1911
US

IV. Provider business mailing address

11221 S TALMAN AVE
CHICAGO IL
60655-1911
US

V. Phone/Fax

Practice location:
  • Phone: 773-653-0339
  • Fax:
Mailing address:
  • Phone: 773-653-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: