Provider Demographics
NPI:1568545549
Name:ALLEY, KIRK P (PHD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:P
Last Name:ALLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OGDEN AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-852-8442
Mailing Address - Fax:630-810-9099
Practice Address - Street 1:1001 OGDEN AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-852-8442
Practice Address - Fax:630-810-9099
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical