Healthcare Provider Details

I. General information

NPI: 1639997430
Provider Name (Legal Business Name): KYRSTEN MCCRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYRSTEN HUME

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W HARLEM AVE
MONMOUTH IL
61462-1007
US

IV. Provider business mailing address

1001 W 2ND AVE
MONMOUTH IL
61462-2015
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-1414
  • Fax:
Mailing address:
  • Phone: 309-299-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: