Individual
KRISTYN JOY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2206 EASTLAND DR STE 101, BLOOMINGTON, IL 61704-7742
(217) 714-7042
Mailing address
1698 FORT JESSE RD APT 2, NORMAL, IL 61761-6236
(618) 704-8454
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/07/2022
Last updated
01/06/2023
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