=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043799646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN CHRISTENSEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2018
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1602 W COLONIAL PKWY UPPR 2
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-364-0163
-----------------------------------------------------
Fax | 847-589-5835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1602 W COLONIAL PKWY STE 200
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-364-0163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C011685
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------