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General NPI Number Information
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NPI Number | 1588528251
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Entity Type | Individual
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Provider Name | KIRSTEN NICOLE JEFFERSON CADC
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Gender | Female
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 620 N STATE ROUTE 31
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City | CRYSTAL LAKE
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State | IL
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Zip | 60012-3714
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Country | US
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Telephone | 815-261-3450
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Fax | 815-261-3451
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Provider Business Mailing Address
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Address Line | 1221 CARDINAL DR
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City | ALGONQUIN
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State | IL
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Zip | 60102-2547
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Country | US
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Telephone | 815-261-3450
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Fax | 815-261-3451
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CADC-45326
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License Number State | IL
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