Provider Demographics
NPI:1558829267
Name:KIEL PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:KIEL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-974-9231
Mailing Address - Street 1:1250 N MILL ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6305
Mailing Address - Country:US
Mailing Address - Phone:630-974-9231
Mailing Address - Fax:
Practice Address - Street 1:1250 N MILL ST STE 102A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6305
Practice Address - Country:US
Practice Address - Phone:630-974-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty