MEDICARE: MS. TONIA M KITCHEL ED.S., IPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist	1307271	IN

General Provider Information

NPI Number	:	1285071464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONIA M KITCHEL ED.S., IPE

Provider Business Mailing Address
First Line	:	751 E PORTER AVE STE 1
Second Line	:
City	:	PORTER
State	:	IN
Zip	:	46304-9111
Country	:	US
Telephone Number	:	219-786-1582
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 E PORTER AVE STE 1
Second Line	:
City	:	PORTER
State	:	IN
Zip	:	46304-9111
Country	:	US
Telephone Number	:	219-786-1582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	10/11/2024

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