Provider Demographics
NPI:1427523695
Name:DYMIT, KIERA MICHELLE
Entity type:Individual
Prefix:MS
First Name:KIERA
Middle Name:MICHELLE
Last Name:DYMIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GINGER TRL APT 6
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-6582
Mailing Address - Country:US
Mailing Address - Phone:708-828-7185
Mailing Address - Fax:
Practice Address - Street 1:211 N VETERANS PKWY STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3568
Practice Address - Country:US
Practice Address - Phone:309-663-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty