Provider Demographics
NPI:1467572610
Name:HABEL, KIM A (PSYD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:HABEL
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 1:210 W. 22ND ST.
Mailing Address - Street 2:SUITE 119
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-571-5716
Mailing Address - Fax:
Practice Address - Street 1:210 W 22ND ST
Practice Address - Street 2:SUITE 119
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1544
Practice Address - Country:US
Practice Address - Phone:630-571-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical