| Doctor Name: | MS. JANE KIDWELL |
| NPI Number: | 1033218086 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | |
| Business Practice Address: | 35 Albany Rd Suite E Carbondale, IL - 629037605 |
| Business Phone Number: | 6182412128 |
| Business Fax Number: | 6182413848 |
| Mailing Address: | Po Box 587, CENTRALIA |
| State: | IL |
| Postal Code: | 628019110 |
| Phone Number: | 6182412128 |
| Fax Number: | 6182413848 |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |