MEDICARE: KRISTIN ERISMAN LPC

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	101YP2500X	Professional Counselor	178011587	IL

General Provider Information

NPI Number	:	1982050647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ERISMAN LPC

Provider Business Mailing Address
First Line	:	422 TRACY CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6288
Country	:	US
Telephone Number	:	815-363-6132
Fax Number	:	815-363-6139

Provider Business Practice Location Address
First Line	:	422 TRACY CT
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6288
Country	:	US
Telephone Number	:	815-363-6132
Fax Number	:	815-363-6139

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

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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