Healthcare Provider Details

I. General information

NPI: 1235067984
Provider Name (Legal Business Name): KYLE JAMES SCHIEBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E LINCOLN ST STE 303
NORMAL IL
61761-6406
US

IV. Provider business mailing address

705 E LINCOLN ST STE 303
NORMAL IL
61761-6406
US

V. Phone/Fax

Practice location:
  • Phone: 309-451-9495
  • Fax: 309-451-9404
Mailing address:
  • Phone: 309-451-9495
  • Fax: 309-451-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: