Provider Demographics
NPI:1699927327
Name:KROLL, KIMBERLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KROLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:KROLL
Other - Last Name:WOLFBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:400 LAKE COOK RD
Mailing Address - Street 2:217
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5607
Mailing Address - Country:US
Mailing Address - Phone:847-914-0560
Mailing Address - Fax:
Practice Address - Street 1:400 LAKE COOK RD
Practice Address - Street 2:217
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5607
Practice Address - Country:US
Practice Address - Phone:847-914-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical