Provider Demographics
NPI:1932442159
Name:DION, KRISTEN E (MAT, ATC, OTC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:DION
Suffix:
Gender:F
Credentials:MAT, ATC, OTC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:HIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, ATC
Mailing Address - Street 1:1051 W US ROUTE 6 STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3370
Mailing Address - Country:US
Mailing Address - Phone:815-942-4875
Mailing Address - Fax:815-942-5046
Practice Address - Street 1:1051 W US ROUTE 6 STE 100
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3370
Practice Address - Country:US
Practice Address - Phone:815-942-4875
Practice Address - Fax:815-942-5046
Is Sole Proprietor?:No
Enumeration Date:2013-04-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0031922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer