Provider Demographics
NPI:1124349568
Name:OSADCHUK, KIMBERLEY (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:OSADCHUK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E ROSSER AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4058
Mailing Address - Country:US
Mailing Address - Phone:701-222-6670
Mailing Address - Fax:
Practice Address - Street 1:415 E ROSSER AVE STE 113
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4058
Practice Address - Country:US
Practice Address - Phone:701-222-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker