Provider Demographics
NPI:1316532195
Name:REICHERT, KRISTA M (LCSW RPT-S)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:REICHERT
Suffix:
Gender:F
Credentials:LCSW RPT-S
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:N
Other - Last Name:REICHERT-LUNNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW RPT-S
Mailing Address - Street 1:11182 E 350 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745-7626
Mailing Address - Country:US
Mailing Address - Phone:309-310-3837
Mailing Address - Fax:
Practice Address - Street 1:707 N EAST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3059
Practice Address - Country:US
Practice Address - Phone:319-224-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.152301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical