Doctor Name: | KIMBERLEY JANE WATEROUS |
NPI Number: | 1043324353 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., LCPC |
License Number: | 180-005544 |
Business Practice Address: | 3s732 Glen Dr S Warrenville, IL - 605553507 |
Business Phone Number: | 6308853443 |
Business Fax Number: | |
Mailing Address: | 3s732 Glen Dr S, WARRENVILLE |
State: | IL |
Postal Code: | 605553507 |
Phone Number: | 6308853443 |
Fax Number: | |
NPI Enumeration Date: | 08/17/2006 |
NPI Last Update Date: | 04/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180-005544 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |