Healthcare Provider Details

I. General information

NPI: 1265043269
Provider Name (Legal Business Name): KRISTIN MARLENA PALMSIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST
OAK PARK IL
60302-3257
US

IV. Provider business mailing address

4525 N OTTAWA AVE
NORRIDGE IL
60706-4516
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax:
Mailing address:
  • Phone: 773-910-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: