Provider Demographics
NPI:1699430967
Name:KIEBLES PSYCHOLOGY SERVICES LLC
Entity type:Organization
Organization Name:KIEBLES PSYCHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-895-7490
Mailing Address - Street 1:0S065 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1208
Mailing Address - Country:US
Mailing Address - Phone:773-895-7490
Mailing Address - Fax:
Practice Address - Street 1:615 W FRONT ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5039
Practice Address - Country:US
Practice Address - Phone:630-923-7814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1598067886OtherNPPES