Provider Demographics
NPI:1427318120
Name:MARTELL, KIMBERLY ANNE (MA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:ZODER-MARTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:128 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3728
Mailing Address - Country:US
Mailing Address - Phone:318-229-1259
Mailing Address - Fax:
Practice Address - Street 1:1111 W 10TH ST # PBA212
Practice Address - Street 2:1224
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4800
Practice Address - Country:US
Practice Address - Phone:317-274-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X.103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool