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General NPI Number Information
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NPI Number | 1922651645
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Entity Type | Individual
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Provider Name | KRISTEN M HAUT
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1750 W. HARRISON, JELKE BUILDING STE 1425
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City | CHICAGO
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State | IL
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Zip | 60612-6061
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Country | US
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Telephone | 312-563-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 N WINCHESTER AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60622-1364
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.009955
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009955
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License Number State | IL
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