Provider Demographics
NPI:1669333225
Name:KIRKUM, AUDRIA R
Entity type:Individual
Prefix:
First Name:AUDRIA
Middle Name:R
Last Name:KIRKUM
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 1:2826 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3269
Mailing Address - Country:US
Mailing Address - Phone:217-428-8380
Mailing Address - Fax:217-428-2981
Practice Address - Street 1:2826 N MONROE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3269
Practice Address - Country:US
Practice Address - Phone:217-428-8380
Practice Address - Fax:217-428-2981
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health