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General NPI Number Information
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NPI Number | 1770221426
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Entity Type | Individual
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Provider Name | KRISTEN MICHELLE CLOW M.A., LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 3233 MATHERS ROAD SUITE A
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City | 62711
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State | IL
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Zip | 62704
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Country | US
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Telephone | 217-414-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 W PINE ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3548
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Country | US
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Telephone | 217-416-0737
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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 | 178.005177
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.005177
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007516
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License Number State | IL
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