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General NPI Number Information
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NPI Number | 1154648160
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Entity Type | Individual
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Provider Name | KELLINE EVANS MATHEWS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 201 E ARMY TRAIL RD STE 306
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2138
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Country | US
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Telephone | 630-539-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E ARMY TRAIL RD STE 306
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2138
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Country | US
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Telephone | 630-539-2620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.005973
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 071.005973
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071.005973
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 071.005973
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License Number State | IL
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