Provider Demographics
NPI:1154648160
Name:MATHEWS, KELLINE EVANS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLINE
Middle Name:EVANS
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E ARMY TRAIL RD STE 306
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2138
Mailing Address - Country:US
Mailing Address - Phone:630-539-2620
Mailing Address - Fax:
Practice Address - Street 1:201 E ARMY TRAIL RD STE 306
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2138
Practice Address - Country:US
Practice Address - Phone:630-539-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.005973103T00000X, 103TA0400X, 103G00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic