Provider Demographics
NPI:1164902219
Name:HART, KIMBERLY ANN (PHD, LCPC, NCC, ACS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:HART
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E LINCOLN HWY UNIT 1104
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7256
Mailing Address - Country:US
Mailing Address - Phone:773-315-5284
Mailing Address - Fax:
Practice Address - Street 1:290 N. ANNIE GLIDDEN DRIVE, GH 416
Practice Address - Street 2:NIU
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-753-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2235576101YS0200X, 101YS0200X
IL178009491101YM0800X
IL180012371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health