Healthcare Provider Details

I. General information

NPI: 1487093092
Provider Name (Legal Business Name): KERRIE ARMSTRONG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 04/01/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 E EMPIRE ST STE A
BLOOMINGTON IL
61704-5402
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-7800
  • Fax:
Mailing address:
  • Phone: 217-902-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071009620
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2016002818
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: