1144762527 NPI number — DR. KATHLEEN CHWALISZ RIGNEY PH.D.

Table of content: DR. KATHLEEN CHWALISZ RIGNEY PH.D. (NPI 1144762527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144762527 NPI number — DR. KATHLEEN CHWALISZ RIGNEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIGNEY
Provider First Name:
KATHLEEN
Provider Middle Name:
CHWALISZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144762527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 LINCOLN DRIVE ROOM 281
Provider Second Line Business Mailing Address:
SOUTHERN ILLINOIS UNIVERSITY DEPARTMENT OF PSYCHOLOGY
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901-6502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-453-3541
Provider Business Mailing Address Fax Number:
618-453-3563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 WEST MILL STREET
Provider Second Line Business Practice Location Address:
NEURORESTORATIVE
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-453-3541
Provider Business Practice Location Address Fax Number:
618-453-3563
Provider Enumeration Date:
11/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  071005073 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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