Provider Demographics
NPI:1790707610
Name:KIMBEL, PATRICIA K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:KIMBEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWER CT
Mailing Address - Street 2:SUITE 245
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3336
Mailing Address - Country:US
Mailing Address - Phone:773-490-7778
Mailing Address - Fax:847-360-2728
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:SUITE 245
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3336
Practice Address - Country:US
Practice Address - Phone:773-490-7778
Practice Address - Fax:847-360-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210637Medicare ID - Type Unspecified