Healthcare Provider Details

I. General information

NPI: 1255447322
Provider Name (Legal Business Name): KIMBERLY A HAYS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 E WASHINGTON ST WASHINGTON ARCHES II, SUITE 108
BLOOMINGTON IL
61704-4478
US

IV. Provider business mailing address

2704 BLARNEY STONE LN
BLOOMINGTON IL
61704-8414
US

V. Phone/Fax

Practice location:
  • Phone: 309-310-1759
  • Fax:
Mailing address:
  • Phone: 309-310-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071004504
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number071004504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: