Provider Demographics
NPI:1164959151
Name:NELSON, KRISTIN ANNA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 N NAPER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8830
Mailing Address - Country:US
Mailing Address - Phone:630-791-5746
Mailing Address - Fax:630-283-8841
Practice Address - Street 1:1804 N NAPER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8830
Practice Address - Country:US
Practice Address - Phone:630-791-5746
Practice Address - Fax:630-283-8841
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490230061041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical