Provider Demographics
NPI:1285050609
Name:JOHNSTONE, KRISTY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OGDEN AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3071
Mailing Address - Country:US
Mailing Address - Phone:630-674-2657
Mailing Address - Fax:
Practice Address - Street 1:515 OGDEN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3071
Practice Address - Country:US
Practice Address - Phone:630-674-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0149611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical