1205041837 NPI number — KRISTINA ELIZABETH ERLAND LCSW

Table of content: KRISTINA ELIZABETH ERLAND LCSW (NPI 1205041837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205041837 NPI number — KRISTINA ELIZABETH ERLAND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERLAND
Provider First Name:
KRISTINA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205041837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5227 N GLENWOOD AVE UNIT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60640-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-339-5848
Provider Business Mailing Address Fax Number:
847-589-2914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 ORRINGTON AVE STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-859-9553
Provider Business Practice Location Address Fax Number:
847-589-2914
Provider Enumeration Date:
05/14/2007

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: 1041C0700X , with the licence number:  149013045 , 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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