Provider Demographics
NPI:1265804330
Name:CLIFFORD, KRISTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E JANATA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5317
Mailing Address - Country:US
Mailing Address - Phone:630-424-8900
Mailing Address - Fax:
Practice Address - Street 1:246 E JANATA BLVD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5317
Practice Address - Country:US
Practice Address - Phone:630-424-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2004878A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical