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General NPI Number Information
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NPI Number | 1306547880
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Entity Type | Individual
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Provider Name | CRISTOL S KLICKER MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 12/09/2023
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Provider Practice Location Address
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Address Line | 344 S GLEN AVE
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City | MORTON
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State | IL
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Zip | 61550-1914
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Country | US
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Telephone | 217-761-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 WINFIELD RD STE 200
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City | WARRENVILLE
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State | IL
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Zip | 60555-4023
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Country | US
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Telephone | 630-423-6425
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150102963
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License Number State | IL
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