Doctor Name: | JANE ELAINE KIMBALL |
NPI Number: | 1013122233 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LBSW |
License Number: | 6802018344 |
Business Practice Address: | 129 N River St Fenton, MI - 484303800 |
Business Phone Number: | 8106290760 |
Business Fax Number: | 8106166268 |
Mailing Address: | 4382 S Genesee Rd, GRAND BLANC |
State: | MI |
Postal Code: | 484397958 |
Phone Number: | 8107443985 |
Fax Number: | 8106166268 |
NPI Enumeration Date: | 05/11/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6802018344 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |