Provider Demographics
NPI:1861515991
Name:SCHILL, KIMBERLY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SCHILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:DUSLEAG-SCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3010 FOX CHASE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8878
Mailing Address - Country:US
Mailing Address - Phone:812-323-7283
Mailing Address - Fax:
Practice Address - Street 1:2125 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3003
Practice Address - Country:US
Practice Address - Phone:812-275-4053
Practice Address - Fax:812-275-5494
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003772A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical