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General NPI Number Information
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NPI Number | 1245550797
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Entity Type | Individual
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Provider Name | KRISTIN MARIE ANDERSON PH.D., LCP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 1250 EXECUTIVE PL SUITE #404
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City | GENEVA
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State | IL
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Zip | 60134-3807
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Country | US
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Telephone | 630-631-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 EXECUTIVE PL SUITE #404
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City | GENEVA
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State | IL
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Zip | 60134-3807
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Country | US
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Telephone | 630-631-2180
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.006406
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.006406
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 071.006406
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 071.006406
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License Number State | IL
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