Provider Demographics
NPI:1154980951
Name:KEILSON, CHRISTINA MARIE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KEILSON
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 1:3350 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7123
Mailing Address - Country:US
Mailing Address - Phone:630-740-2528
Mailing Address - Fax:331-707-5293
Practice Address - Street 1:3350 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7123
Practice Address - Country:US
Practice Address - Phone:630-740-2528
Practice Address - Fax:331-707-5293
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst