Provider Demographics
NPI:1588094403
Name:KESSLER, KENNETH (PHD, MSCP)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KESSLER
Suffix:
Gender:M
Credentials:PHD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-0695
Mailing Address - Country:US
Mailing Address - Phone:708-579-0974
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 120
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6540
Practice Address - Country:US
Practice Address - Phone:708-579-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL074-000015103TP0016X
IL071-005277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical