Provider Demographics
NPI:1285071464
Name:KITCHEL, TONIA M (EDS, IPE)
Entity type:Individual
Prefix:MS
First Name:TONIA
Middle Name:M
Last Name:KITCHEL
Suffix:
Gender:F
Credentials:EDS, IPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 E PORTER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9111
Mailing Address - Country:US
Mailing Address - Phone:219-786-1582
Mailing Address - Fax:
Practice Address - Street 1:751 E PORTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:IN
Practice Address - Zip Code:46304-9111
Practice Address - Country:US
Practice Address - Phone:219-786-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1307271103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities