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Organization
CHILD AND ADOLESCENT NEUROPSYCHOLOGY SERVICES OF SOUTHERN ILLINOIS, PL
Active
Organization
CHILD AND ADOLESCENT NEUROPSYCHOLOGY SERVICES OF SOUTHERN ILLINOIS, PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE YVONNE KIBBY-FAGLIER PHD (CLINICAL NEUROPSYCHOLOGIST)
(618) 201-8828
Entity
Organization
Contact information
Practice address
285 LAKE INDIAN HILLS DR, CARBONDALE, IL 62902-6184
(618) 490-1263
Mailing address
285 LAKE INDIAN HILLS DR, CARBONDALE, IL 62902-6184
(618) 490-1263
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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