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General NPI Number Information
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NPI Number | 1013505619
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Entity Type | Individual
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Provider Name | CAITLIN CRISSEY
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Gender | Female
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 4230 N PARKSIDE AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1825
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Country | US
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Telephone | 630-291-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 220 DES PLAINES AVE UNIT D
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City | FOREST PARK
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State | IL
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Zip | 60130-1227
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Country | US
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Telephone | 773-636-6131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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