Provider Demographics
NPI:1760344634
Name:KINNEY, ISAAC THOMAS
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:THOMAS
Last Name:KINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ISAAC
Other - Middle Name:THOMAS
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1179
Mailing Address - Country:US
Mailing Address - Phone:217-939-6759
Mailing Address - Fax:
Practice Address - Street 1:722 W COUNTY RD STE F
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2598
Practice Address - Country:US
Practice Address - Phone:618-226-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician