Provider Demographics
NPI:1285922658
Name:JONES, KIMBERLEY R (LSCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 S BONN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-2136
Mailing Address - Country:US
Mailing Address - Phone:316-640-4078
Mailing Address - Fax:
Practice Address - Street 1:3450 S BONN AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2136
Practice Address - Country:US
Practice Address - Phone:316-640-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS38931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical