Healthcare Provider Details

I. General information

NPI: 1538326665
Provider Name (Legal Business Name): CHICAGO'S HIGH ACHIEVERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E GOLF RD STE 395D
SCHAUMBURG IL
60173-5090
US

IV. Provider business mailing address

12524 S STEWART AVE
CHICAGO IL
60628-7231
US

V. Phone/Fax

Practice location:
  • Phone: 773-791-4558
  • Fax:
Mailing address:
  • Phone: 312-382-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number060009907
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JINNIE KWON CRISTERNA
Title or Position: PRESIDENT
Credential: LCSW, CHT., RH.D.
Phone: 312-382-8710