MEDICARE: KRISTINA KAUTH LSW

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	150.118105	IL

General Provider Information

NPI Number	:	1255140950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KAUTH LSW

Provider Business Mailing Address
First Line	:	1790 NATIONS DR STE 214
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-9176
Country	:	US
Telephone Number	:	844-287-3801
Fax Number	:	877-428-7891

Provider Business Practice Location Address
First Line	:	1790 NATIONS DR STE 214
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-9176
Country	:	US
Telephone Number	:	844-287-3801
Fax Number	:	877-428-7891

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	12/29/2025

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Directions to “ KRISTINA KAUTH LSW” Practice Location

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