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General NPI Number Information
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NPI Number | 1285172205
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Entity Type | Individual
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Provider Name | DR. MICHAEL KESSLER
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Gender | Male
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 11/04/2023
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Provider Practice Location Address
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Address Line | 4481 ASH GROVE DR STE B
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City | SPRINGFIELD
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State | IL
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Zip | 62711-6359
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Country | US
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Telephone | 217-751-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 CARNOUSTIE DR
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City | SPRINGFIELD
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State | IL
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Zip | 62712-5548
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Country | US
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Telephone | 217-751-8995
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008495
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License Number State | IL
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