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General NPI Number Information
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NPI Number | 1114437357
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Entity Type | Individual
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Provider Name | KRISTEN SUDNIK
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 212
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City | CHICAGO
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State | IL
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Zip | 60625-1037
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Country | US
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Telephone | 773-998-4123
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Fax |
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Provider Business Mailing Address
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Address Line | 3159 N SEMINARY AVE APT 307
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City | CHICAGO
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State | IL
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Zip | 60657-3359
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Country | US
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Telephone | 248-821-9152
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1826202
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License Number State | IL
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