Basic Information
| Provider Information | |||||||||
| NPI: | 1225021033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREBS | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790 | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620250790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186929640 | ||||||||
| FaxNumber: | 6186929643 | ||||||||
| Practice Location | |||||||||
| Address1: | 103A SOUTH POINTE DRIVE | ||||||||
| Address2: | |||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186562000 | ||||||||
| FaxNumber: | 6186561169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 07/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149008998 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.