Provider Demographics
NPI:1568142602
Name:WALSTRUM, KRISTIE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:WALSTRUM
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CENTRAL AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3246
Mailing Address - Country:US
Mailing Address - Phone:847-432-4981
Mailing Address - Fax:
Practice Address - Street 1:777 CENTRAL AVE STE 17
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3246
Practice Address - Country:US
Practice Address - Phone:847-432-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional