Provider Demographics
NPI:1174047138
Name:KRISTIN PADERA MA LCPC INC.
Entity type:Organization
Organization Name:KRISTIN PADERA MA LCPC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:GEORGIANNE
Authorized Official - Last Name:PADERA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:630-940-9628
Mailing Address - Street 1:1131 WHEATON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3181
Mailing Address - Country:US
Mailing Address - Phone:630-940-6828
Mailing Address - Fax:
Practice Address - Street 1:1131 WHEATON OAKS CT
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3181
Practice Address - Country:US
Practice Address - Phone:630-940-6828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010302101YA0400X, 101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700501962Medicaid
IL1902404650Medicaid
IL1932685732Medicaid
IL1023550282Medicaid
IL1114323359Medicaid
IL1528795739Medicaid
IL1962127019Medicaid