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General NPI Number Information
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NPI Number | 1548688682
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Entity Type | Individual
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Provider Name | KRYSTAL GLASSMAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2014
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 937 HAPP RD
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City | NORTHFIELD
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State | IL
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Zip | 60093-1006
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Country | US
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Telephone | 312-728-8574
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Fax |
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Provider Business Mailing Address
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Address Line | 34 UNIVERSITY DR
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4340
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Country | US
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Telephone | 847-343-3875
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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 | 180.013647
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License Number State | IL
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