Provider Demographics
NPI:1396159059
Name:SMALLWOOD, KIMBERLY LYNN (MSW, LISW-S)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060-9777
Mailing Address - Country:US
Mailing Address - Phone:937-642-1065
Mailing Address - Fax:937-642-2169
Practice Address - Street 1:120 EAST TOWNSEND STREET
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060-9777
Practice Address - Country:US
Practice Address - Phone:937-935-3028
Practice Address - Fax:937-612-4097
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0009151 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical