Healthcare Provider Details

I. General information

NPI: 1285149310
Provider Name (Legal Business Name): CHARLENE KIEFFER M.ED., ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N RAYNOR AVE
JOLIET IL
60435-6065
US

IV. Provider business mailing address

420 N RAYNOR AVE
JOLIET IL
60435-6065
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-3196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: