Individual
KRISTIN A ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
1304 W BRADLEY AVE, CHAMPAIGN, IL 61821-2035
(217) 356-9176
(217) 398-7137
Mailing address
701 W CHURCH ST APT 1, CHAMPAIGN, IL 61820-3393
(217) 621-7129
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801952817
—
IL
Enumeration date
10/22/2019
Last updated
10/22/2019
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