Individual
KRISTIN E THIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1802 S MATTIS AVE, CHAMPAIGN, IL 61821-5923
(217) 365-2855
(217) 365-2856
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-6941
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071009719
IL
Other
Enumeration date
01/30/2018
Last updated
01/30/2018
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