Provider Demographics
NPI:1598067886
Name:KIEBLES, JENNIFER LEA (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:KIEBLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0S065 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1208
Mailing Address - Country:US
Mailing Address - Phone:773-895-7490
Mailing Address - Fax:
Practice Address - Street 1:0S065 RIVER LN
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1208
Practice Address - Country:US
Practice Address - Phone:630-923-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical