Healthcare Provider Details

I. General information

NPI: 1841665106
Provider Name (Legal Business Name): KIRSTEN OLIVIA KNIGHT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15130 S ROUTE 59 STE 201
PLAINFIELD IL
60544-2788
US

IV. Provider business mailing address

15130 S ROUTE 59 STE 201
PLAINFIELD IL
60544-2788
US

V. Phone/Fax

Practice location:
  • Phone: 630-881-6840
  • Fax:
Mailing address:
  • Phone: 630-881-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178011549
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011463
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier180.011463
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: