Provider Demographics
NPI:1447793732
Name:REISER, KIMBERLY M (MA, NCC, CAADC, LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:REISER
Suffix:
Gender:F
Credentials:MA, NCC, CAADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SPUHLER DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1624
Mailing Address - Country:US
Mailing Address - Phone:847-530-6425
Mailing Address - Fax:
Practice Address - Street 1:125 SPUHLER DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1624
Practice Address - Country:US
Practice Address - Phone:847-530-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional