Provider Demographics
NPI:1053410068
Name:MUNSON, KIRSTEN M (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:M
Last Name:MUNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 BAY SCOTT CIR
Mailing Address - Street 2:SUITE105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1114
Mailing Address - Country:US
Mailing Address - Phone:630-305-0464
Mailing Address - Fax:630-305-0211
Practice Address - Street 1:1831 BAY SCOTT CIR
Practice Address - Street 2:SUITE105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1114
Practice Address - Country:US
Practice Address - Phone:630-305-0464
Practice Address - Fax:630-305-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02228114OtherBCBS PROVIDER #