Provider Demographics
NPI:1982444964
Name:KRIDER, CARLIE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:KRIDER
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 1:3804 N OAKLEY AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3814
Mailing Address - Country:US
Mailing Address - Phone:574-304-3566
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4024
Practice Address - Country:US
Practice Address - Phone:847-559-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker