Provider Demographics
NPI:1447722129
Name:LOUCKS, KIMBERLY (PSYD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 FOXFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1403
Mailing Address - Country:US
Mailing Address - Phone:630-797-9332
Mailing Address - Fax:630-246-3410
Practice Address - Street 1:2580 FOXFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1403
Practice Address - Country:US
Practice Address - Phone:630-797-9332
Practice Address - Fax:630-246-3410
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty