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Individual

MARILYN L KOHL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
6 DUNLAP CT, SAVOY, IL 61874-9501
(217) 369-8508
Mailing address
6 DUNLAP CT, SAVOY, IL 61874-9501
(217) 369-8508

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-002885
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1072019
BLUE CROSS BLUE SHIELD
IL
01
34388
NATIONAL REGISTER OF HEAL
IL
Enumeration date
02/08/2007
Last updated
02/06/2017
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