Provider Demographics
NPI:1669777181
Name:KIMBALL, PATRICIA JOAN (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 BENTON ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2850
Mailing Address - Country:US
Mailing Address - Phone:708-704-6973
Mailing Address - Fax:708-481-5466
Practice Address - Street 1:1375 BENTON ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2850
Practice Address - Country:US
Practice Address - Phone:708-704-6973
Practice Address - Fax:708-481-5466
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional