Provider Demographics
NPI:1154084143
Name:KINDEM, ANNELIESE (LCSW)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:
Last Name:KINDEM
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 DALIDIO DR
Mailing Address - Street 2:P.O. BOX 4641
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1000
Mailing Address - Country:US
Mailing Address - Phone:818-429-3011
Mailing Address - Fax:
Practice Address - Street 1:2975 MCMILLAN AVE STE 160
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6768
Practice Address - Country:US
Practice Address - Phone:805-781-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1152831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical