Provider Demographics
NPI:1285432906
Name:WATERHOUSE, KRISTIN R
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:R
Last Name:WATERHOUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 HICKORY POINT FRONTAGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9773
Mailing Address - Country:US
Mailing Address - Phone:217-886-4182
Mailing Address - Fax:
Practice Address - Street 1:5130 HICKORY POINT FRONTAGE RD STE 5
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9773
Practice Address - Country:US
Practice Address - Phone:217-886-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor