Healthcare Provider Details

I. General information

NPI: 1871811687
Provider Name (Legal Business Name): TRUDI MARIE KESSLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 CHEROKEE DR
INDIAN HEAD PARK IL
60525-4322
US

IV. Provider business mailing address

6505 CHEROKEE DR
INDIAN HEAD PARK IL
60525-4322
US

V. Phone/Fax

Practice location:
  • Phone: 708-819-1808
  • Fax:
Mailing address:
  • Phone: 708-819-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.005195
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146-001760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: