Provider Demographics
NPI:1306247051
Name:BUEHNE, KRISTINA G
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:G
Last Name:BUEHNE
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 1:108 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1792
Mailing Address - Country:US
Mailing Address - Phone:618-979-3943
Mailing Address - Fax:
Practice Address - Street 1:108 GRANT DR
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1792
Practice Address - Country:US
Practice Address - Phone:618-979-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2472775222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist