| Doctor Name: | DR. KIMBERLY SUE VANHAITSMA |
| NPI Number: | 1063655371 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D |
| License Number: | PS006311L |
| Business Practice Address: | 1425 Horsham Rd North Wales, PA - 194541320 |
| Business Phone Number: | 2153711895 |
| Business Fax Number: | 2153713015 |
| Mailing Address: | 388 Cobbler Ct, YARDLEY |
| State: | PA |
| Postal Code: | 190674752 |
| Phone Number: | 2153711895 |
| Fax Number: | 2153713015 |
| NPI Enumeration Date: | 04/16/2009 |
| NPI Last Update Date: | 04/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS006311L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |