Healthcare Provider Details

I. General information

NPI: 1518582824
Provider Name (Legal Business Name): KRISTA ESCAMILLO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 VETERANS PKWY
NEW LENOX IL
60451-2899
US

IV. Provider business mailing address

301 VETERANS PKWY
NEW LENOX IL
60451-2899
US

V. Phone/Fax

Practice location:
  • Phone: 815-954-0022
  • Fax:
Mailing address:
  • Phone: 815-954-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: