Provider Demographics
NPI:1790876472
Name:KIEL, SHERYL LYNN (MA LLP)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:LYNN
Last Name:KIEL
Suffix:
Gender:F
Credentials:MA LLP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-2585
Mailing Address - Country:US
Mailing Address - Phone:269-381-0150
Mailing Address - Fax:269-373-4720
Practice Address - Street 1:8036 MOORSBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4417
Practice Address - Country:US
Practice Address - Phone:269-327-1438
Practice Address - Fax:269-327-6454
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301007441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist