Healthcare Provider Details

I. General information

NPI: 1558272260
Provider Name (Legal Business Name): KAPRIELLE J STREETER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAIN ST
OSWEGO IL
60543-1264
US

IV. Provider business mailing address

25231 BALMORAL DR
SHOREWOOD IL
60404-8372
US

V. Phone/Fax

Practice location:
  • Phone: 630-733-9108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: