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General NPI Number Information
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NPI Number | 1306236005
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Entity Type | Individual
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Provider Name | KIMBERLY SWISS PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 04/27/2019
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE STE 614
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City | CHICAGO
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State | IL
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Zip | 60601-3938
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Country | US
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Telephone | 773-983-8478
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Fax |
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Provider Business Mailing Address
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Address Line | 800 MAIN ST STE 210
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City | ANTIOCH
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State | IL
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Zip | 60002-1578
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Country | US
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Telephone |
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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 | 71008882
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License Number State | IL
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