Individual
KAREN ELAINE KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
2323 WINDISH DR, GALESBURG, IL 61401-9780
(309) 344-2323
(309) 344-4368
Mailing address
2323 WINDISH DR, GALESBURG, IL 61401-9780
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
150012656
IL
104100000X
Social Worker
Primary
150012656
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370984175
FEIN
IL
Enumeration date
02/08/2011
Last updated
04/03/2017
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