MEDICARE: KRISTIE BATTS

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	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1780394163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE BATTS

Provider Business Mailing Address
First Line	:	11724 S SANGAMON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-5234
Country	:	US
Telephone Number	:	773-750-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	11724 S SANGAMON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-5234
Country	:	US
Telephone Number	:	773-750-0152
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “ KRISTIE BATTS ” Practice Location

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