Healthcare Provider Details

I. General information

NPI: 1134494594
Provider Name (Legal Business Name): KRISTIN L WATERFIELD M.A., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARTIN AVE
NAPERVILLE IL
60540-6536
US

IV. Provider business mailing address

110 S WASHINGTON ST APT 206
NAPERVILLE IL
60540-5684
US

V. Phone/Fax

Practice location:
  • Phone: 630-848-1200
  • Fax: 630-848-1208
Mailing address:
  • Phone: 630-862-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: