Provider Demographics
NPI:1316708001
Name:DVORAK, KIMBERLY NEWTON
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NEWTON
Last Name:DVORAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1344
Mailing Address - Country:US
Mailing Address - Phone:507-512-4069
Mailing Address - Fax:
Practice Address - Street 1:7345 ADVENTURE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5000
Practice Address - Country:US
Practice Address - Phone:720-644-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor