Individual
KAYLA NEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCSP, SSP
Contact information
Practice address
607 N WORRELL ST, BOWEN, IL 62316-1048
(217) 842-5236
Mailing address
PO BOX 215, AUGUSTA, IL 62311-0215
(217) 392-2125
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
904011
IL
Other
Enumeration date
08/23/2017
Last updated
03/17/2018
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