Provider Demographics
NPI:1912253550
Name:KIEL, JENNA STOWELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:STOWELL
Last Name:KIEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:STOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1218 MEADOWWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7710
Mailing Address - Country:US
Mailing Address - Phone:630-974-9231
Mailing Address - Fax:
Practice Address - Street 1:1250 N MILL ST STE 102A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6305
Practice Address - Country:US
Practice Address - Phone:630-448-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical