Provider Demographics
NPI:1326358607
Name:CODDING, KIM A (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:CODDING
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:A
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1304 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2770
Mailing Address - Country:US
Mailing Address - Phone:406-579-4285
Mailing Address - Fax:
Practice Address - Street 1:1304 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2770
Practice Address - Country:US
Practice Address - Phone:406-579-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1370101YA0400X
MT24211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)