Provider Demographics
NPI:1821465006
Name:KIEL, MARK (PSYD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KIEL
Suffix:
Gender:M
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 SPINNING WHEEL RD
Mailing Address - Street 2:SUITE 426
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2914
Mailing Address - Country:US
Mailing Address - Phone:630-323-3050
Mailing Address - Fax:630-323-3058
Practice Address - Street 1:15 SPINNING WHEEL RD
Practice Address - Street 2:SUITE 426
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:630-323-3050
Practice Address - Fax:630-323-3058
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist