Provider Demographics
NPI:1144017096
Name:ANDERSON, KRISTINA L (CSSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CSSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:SMITH-ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 S MICHIGAN AVE APT 1902
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4840
Mailing Address - Country:US
Mailing Address - Phone:708-288-1875
Mailing Address - Fax:
Practice Address - Street 1:1720 S MICHIGAN AVE APT 1902
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4840
Practice Address - Country:US
Practice Address - Phone:708-288-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7027471041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty