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General NPI Number Information
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NPI Number | 1114781101
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Entity Type | Individual
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Provider Name | KRISTINA MARIE BILLADEAU LPC
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Gender | Female
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 1137 E 5000N RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4229
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Country | US
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Telephone | 815-216-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 212 N CLINTON AVE
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City | BRADLEY
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State | IL
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Zip | 60915-1714
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Country | US
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Telephone | 815-955-9528
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.019756
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License Number State | IL
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