Individual
CHRISTINE LEIGH KMIECIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-9355
Mailing address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-9355
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/10/2012
Last updated
08/04/2025
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