CHILD AND ADOLESCENT NEUROPSYCHOLOGY SERVICES OF SOUTHERN ILLINOIS, PL (NPI# 1255961348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255961348 |
| Entity Type | Organization |
| Organization Name | CHILD AND ADOLESCENT NEUROPSYCHOLOGY SERVICES OF SOUTHERN ILLINOIS, PL |
| Practice Address |
285 Lake Indian Hills Dr Carbondale IL 62902-6184 |
| Practice Telephone | 6184901263 |
| Mailing Telephone | 6184901263 |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |
| Authorized Official Name | MICHELLE YVONNE KIBBY-FAGLIER (CLINICAL NEUROPSYCHOLOGIST) |
| Authorized Official Telephone | 6182018828 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
285 LAKE INDIAN HILLS DR |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62902-6184 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477183556 | Michelle Yvonne Kibby-faglier | Clinical Neuropsychologist | 285 Lake Indian Hills Dr, Carbondale, IL 62902-6184 | 2020-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114200482 | Pamela K. Zeigler | Speech-Language Pathologist | 2880 Wolf Creek Road, Carbondale, IL 62902 | 2011-09-23 |
| 1043504541 | Melanie Wick Singer | Speech-Language Pathologist | 51 Carolyn Drive, #q, Carbondale, IL 62902 | 2011-06-02 |
| 1518286624 | Kaci Moeller | Physical Therapist | 2001e Creekwood, Carbondale, IL 62902 | 2010-05-28 |
| 1417173782 | Debra Lynn Braunling Mcmorrow | Psychologist | 306 W Mill Street, 2nd Floor, Carbondale, IL 62902 | 2007-04-17 |
| 1942352083 | Damaris Miltenberger Language & Learning Center, Ltd | Speech-Language Pathologist | 301 S. Wall St., Suite B, Carbondale, IL 62902 | 2007-01-17 |
| 1013288968 | Jenny Moss Occupational Therapy Services, Inc. | Early Intervention Provider Agency | 7207 Grassy Rd, Carbondale, IL 62902-0465 | 2012-01-24 |
| 1114482734 | Erin Anderson | Occupational Therapy Assistant | 2595 S Wolf Creek Rd, Carbondale, IL 62902-0572 | 2019-02-07 |
| 1679749576 | Gina M. Hill | Student in an Organized Health Care Education/Training Program | 4269 Lager Ln, Carbondale, IL 62902-0970 | 2008-05-01 |
| 1649712829 | Carolyn Fasnacht | Student in an Organized Health Care Education/Training Program | 2775 Skyhawk Rd, Carbondale, IL 62902-1008 | 2016-11-05 |
| 1235627654 | Brandy S Smith | Behavioral Analyst | 136 Premier Ln, Carbondale, IL 62902-4101 | 2018-05-01 |
| Find all providers in zip 62902 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447461587 | Kids' Cornerstone, LLC- A Counseling Center | Clinic/Center | 1257 E Walnut St, Suite 1, Carbondale, IL 62901-5002 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891393781 | Camelot Care Centers, LLC | Clinic/Center | 34121 North Route 45 Suite 207, Grayslake, IL 60030 | 2020-10-13 |
| 1831797141 | Camelot Care Centers, LLC | Clinic/Center | 5301 E State St Ste 208, Rockford, IL 61108-2397 | 2020-10-09 |
| 1255954780 | The Transformation Specialists LLC | Clinic/Center | 813 Ash St, Flossmoor, IL 60422-2213 | 2020-05-19 |
| 1689296162 | Kmetko & Associates, Ltd. | Clinic/Center | 4043 N Ravenswood Ave Ste 121, Chicago, IL 60613-1176 | 2020-05-07 |
| 1962035709 | Ellen M Griffin Psyd PC | Clinic/Center | 155 N Michigan Ave Ste 512, Chicago, IL 60601-7612 | 2020-02-20 |
| 1962034488 | Global Executive Council Services | Clinic/Center | 5766 N Lincoln Ave Ste 4s, Chicago, IL 60659-4734 | 2020-02-12 |
| 1366082232 | Westcare Illinois, Inc | Clinic/Center | 1100 W Cermak Rd Ste B116, Chicago, IL 60608-4540 | 2020-01-08 |
| 1295379972 | Compass Health Center Oakbrook Pllc | Clinic/Center | 700 Oakmont Ln, Westmont, IL 60559-5551 | 2019-11-05 |
| 1427690676 | Midwest Family and Community Resources PC | Clinic/Center | 3330 W 177th St Fl 1, Hazel Crest, IL 60429-2184 | 2019-10-09 |
| 1720629041 | Monte Nido Illinois, LLC | Clinic/Center | 27w121 80th St, Naperville, IL 60565-1270 | 2019-10-08 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62902 |
Please comment or provide details below to improve the information on CHILD AND ADOLESCENT NEUROPSYCHOLOGY SERVICES OF SOUTHERN ILLINOIS, PL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.