Provider Demographics
NPI:1033752282
Name:SPRENKLE, KEVIN P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:SPRENKLE
Suffix:
Gender:M
Credentials:PSYD
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 584
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-0140
Mailing Address - Country:US
Mailing Address - Phone:630-755-5300
Mailing Address - Fax:331-236-0370
Practice Address - Street 1:2135 CITY GATE LN STE 300
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3066
Practice Address - Country:US
Practice Address - Phone:630-755-5300
Practice Address - Fax:331-236-0370
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.01041103TC0700X
IL071.010141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical