Provider Demographics
NPI:1366754095
Name:PHILLIPS, KIMBERLY ANN (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 THOREAU DR N STE 180
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4151
Mailing Address - Country:US
Mailing Address - Phone:847-496-5513
Mailing Address - Fax:
Practice Address - Street 1:1920 THOREAU DR N STE 180
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4151
Practice Address - Country:US
Practice Address - Phone:847-496-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst