Provider Demographics
NPI:1063590008
Name:NEDROW, KIMBERLY J (LMP BCTMB CST-D)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:NEDROW
Suffix:
Gender:F
Credentials:LMP BCTMB CST-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 KENYON ST NW STE 103
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4581
Mailing Address - Country:US
Mailing Address - Phone:360-956-3771
Mailing Address - Fax:360-352-5855
Practice Address - Street 1:221 KENYON ST NW STE 103
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4581
Practice Address - Country:US
Practice Address - Phone:360-705-1133
Practice Address - Fax:360-352-5855
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist