Provider Demographics
NPI:1275937203
Name:KINDLER, MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KINDLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 VALE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4648
Mailing Address - Country:US
Mailing Address - Phone:815-209-6061
Mailing Address - Fax:
Practice Address - Street 1:6085 STRATHMOOR DR STE 1C
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6636
Practice Address - Country:US
Practice Address - Phone:815-435-0907
Practice Address - Fax:815-435-5251
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9454-1231041C0700X
IL149.0170041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275937203Medicaid