Provider Demographics
NPI:1831221381
Name:KOBUS, KIMBERLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KOBUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:KOBUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1001 E CHICAGO AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5500
Mailing Address - Country:US
Mailing Address - Phone:630-585-3988
Mailing Address - Fax:
Practice Address - Street 1:205 E BENSON BLVD STE 518
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4019
Practice Address - Country:US
Practice Address - Phone:630-585-3988
Practice Address - Fax:630-585-3988
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10242831103TC0700X
IL060-009249103TC0700X
IL071-006044103TC0700X
AK209075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204489162OtherS-CORP TAX ID #