Provider Demographics
NPI:1619368693
Name:NANCYKKINLEY
Entity Type:Organization
Organization Name:NANCYKKINLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KERR
Authorized Official - Last Name:KINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-945-7969
Mailing Address - Street 1:105 HILLTOP ST
Mailing Address - Street 2:
Mailing Address - City:COLONA
Mailing Address - State:IL
Mailing Address - Zip Code:61241-8819
Mailing Address - Country:US
Mailing Address - Phone:309-945-7969
Mailing Address - Fax:309-441-6085
Practice Address - Street 1:105 HILLTOP ST
Practice Address - Street 2:
Practice Address - City:COLONA
Practice Address - State:IL
Practice Address - Zip Code:61241-8819
Practice Address - Country:US
Practice Address - Phone:309-945-7969
Practice Address - Fax:309-441-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.010286252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency