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General NPI Number Information
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NPI Number | 1255654265
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Entity Type | Individual
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Provider Name | GLENNA V. KRECKMAN HIETT L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 17498 N LIVINGSTON RD
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City | MARSHALL
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State | IL
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Zip | 62441-4551
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Country | US
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Telephone | 217-826-3477
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Fax | 773-326-0633
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Provider Business Mailing Address
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Address Line | 17498 N LIVINGSTON RD
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City | MARSHALL
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State | IL
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Zip | 62441-4551
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Country | US
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Telephone | 217-826-3477
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Fax | 773-326-0633
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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 | 166000184
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000184
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License Number State | IL
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