Provider Demographics
NPI:1316527179
Name:HELLSTROM, KASANDRA (CNA)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:HELLSTROM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 CARROLL SQ # GW1
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1578
Mailing Address - Country:US
Mailing Address - Phone:815-231-6796
Mailing Address - Fax:
Practice Address - Street 1:2625 TECHNY RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5995
Practice Address - Country:US
Practice Address - Phone:224-412-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide