IndividualActive
Jeffrey Kellogg, PSY.D
NPI 1093740862 · Clinical Child & Adolescent Psychologist · Carbondale, IL
Provider details
- NPI number
- 1093740862
- Entity type
- Individual
- Primary specialty
- Clinical Child & Adolescent PsychologistBehavioral Health & Social Service Providers
- Credential
- PSY.D
- Sex
- Male
- Sole proprietor
- Yes
- License
- 071003739 (IL)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Behavioral Health & Social Service Providers
Practice location
3412 S Illinois Ave
Carbondale, IL 62903-8362
Phone: (618) 457-4488
Fax: (618) 457-8844
Approximate (ZIP-level) locationGet directions
Mailing address
3412 S Illinois Ave
Carbondale, IL 62903-8362
Registry dates
- Enumerated
- 2006-07-11
- Last updated
- 2015-03-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.