Healthcare Provider Details

I. General information

NPI: 1457282949
Provider Name (Legal Business Name): KRISTIN ASHLEY BONDLOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 LASALLE STREET
OTTAWA IL
61350
US

IV. Provider business mailing address

140 CHESTNUT ST
BUCKINGHAM IL
60917-1005
US

V. Phone/Fax

Practice location:
  • Phone: 815-823-2418
  • Fax:
Mailing address:
  • Phone: 815-823-2418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.029363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: