Provider Demographics
NPI:1144629361
Name:MINER, KRISTIANA (MT-BC)
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PINE CONE CT
Mailing Address - Street 2:APT 112
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4757
Mailing Address - Country:US
Mailing Address - Phone:309-831-5545
Mailing Address - Fax:
Practice Address - Street 1:2 PINE CONE CT
Practice Address - Street 2:APT 112
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4757
Practice Address - Country:US
Practice Address - Phone:309-831-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL09295225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist