Active NPI
Kiela Bolden, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1134514524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.008892
- Practice address
- 205 W Randolph St
Ste 830
Chicago, IL 60606-1867 - Phone
- (312) 834-7239
- NPI assigned
- Apr 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.008892 | IL | Primary |
Addresses
Primary practice location
205 W Randolph St
Ste 830
Chicago, IL 60606-1867
Mailing address
1451 E 55TH St
Unit 227N
Chicago, IL 60615-5429
Phone (773) 742-4887
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008892 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1134514524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1451 E 55TH ST",
"address_2": "UNIT 227N",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606155429",
"telephone_number": "773-742-4887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 W RANDOLPH ST",
"address_2": "STE 830",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606061867",
"telephone_number": "312-834-7239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDEN",
"first_name": "KIELA",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-02",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.008892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.