Provider Demographics
NPI:1336873082
Name:MEYERS, KRISTINA JOANNE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOANNE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30031 N WAUKEGAN RD APT 103
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1091
Mailing Address - Country:US
Mailing Address - Phone:269-569-5279
Mailing Address - Fax:
Practice Address - Street 1:30031 N WAUKEGAN RD APT 103
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1091
Practice Address - Country:US
Practice Address - Phone:269-569-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48906591041C0700X
MI68011143041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical