1073546016 NPI number — MS. CHRISTINE MARGARET ABT APN, CS.

Table of content: MS. CHRISTINE MARGARET ABT APN, CS. (NPI 1073546016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073546016 NPI number — MS. CHRISTINE MARGARET ABT APN, CS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABT
Provider First Name:
CHRISTINE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN, CS.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAACK
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN, CS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073546016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 WIRTZ RD
Provider Second Line Business Mailing Address:
HEALTH SERVICES
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-753-1311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ADVANCE PSYCHIATRY AND COUNSELING
Provider Second Line Business Practice Location Address:
BILLING DEPT. 5973
Provider Business Practice Location Address City Name:
CAROL STREAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60122-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-855-2614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0812X , with the licence number:  209-004215 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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