Provider Demographics
NPI:1003794488
Name:KORDUS, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KORDUS
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 1:4406 NORTHMONT CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8135
Mailing Address - Country:US
Mailing Address - Phone:815-414-3747
Mailing Address - Fax:
Practice Address - Street 1:4406 NORTHMONT CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8135
Practice Address - Country:US
Practice Address - Phone:815-414-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician