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1306547880 NPI number — CRISTOL S KLICKER MSW, LSW

NPI Number: 1306547880
Health Care Provider/Practitioner: CRISTOL S KLICKER MSW, LSW

Information about “1306547880” NPI (CRISTOL S KLICKER MSW, LSW) exists in 1306547880 in HTML format HTML  |  1306547880 in plain Text format TXT  |  1306547880 in PDF (Portable Document Format) PDF  |  1306547880 in an XML format XML  formats.

NPI Number : 1306547880 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306547880",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KLICKER",
    "FirstName": "CRISTOL",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW, LSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4320 WINFIELD RD STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARRENVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60555-4023",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-423-6425",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "344 S GLEN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61550-1914",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-761-4942",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/13/2023",
    "LastUpdateDate": "12/09/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "150102963",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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