MEDICARE: KRISTIN ANNA NELSON MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149023006	IL

General Provider Information

NPI Number	:	1164959151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ANNA NELSON MSW, LCSW

Provider Business Mailing Address
First Line	:	1804 N NAPER BLVD STE 250
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8830
Country	:	US
Telephone Number	:	630-791-5746
Fax Number	:	630-283-8841

Provider Business Practice Location Address
First Line	:	1804 N NAPER BLVD STE 250
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8830
Country	:	US
Telephone Number	:	630-791-5746
Fax Number	:	630-283-8841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/16/2024

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