Provider Demographics
NPI:1497343123
Name:TISCIA, KIMBERLY S
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:TISCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13246 S ROUTE 59 # 102A
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9800
Mailing Address - Country:US
Mailing Address - Phone:630-296-7639
Mailing Address - Fax:
Practice Address - Street 1:13246 S ROUTE 59 # 102A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9800
Practice Address - Country:US
Practice Address - Phone:630-296-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical