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General NPI Number Information
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NPI Number | 1699430967
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Entity Type | Organization
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Legal Business Name | KIEBLES PSYCHOLOGY SERVICES LLC
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 615 W FRONT ST
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City | WHEATON
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State | IL
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Zip | 60187-5039
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Country | US
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Telephone | 630-923-7814
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Fax |
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Provider Business Mailing Address
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Address Line | 0S065 RIVER LN
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City | WINFIELD
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State | IL
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Zip | 60190-1208
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Country | US
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Telephone | 773-895-7490
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER L KIEBLES
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Credential | PHD
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Telephone | 773-895-7490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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