Provider Demographics
NPI:1831332899
Name:RICHARDSON, KIMBERLY MARIE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:RICHARDSON
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 1:1010 2ND ST
Mailing Address - Street 2:APT # 6
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-1770
Mailing Address - Country:US
Mailing Address - Phone:406-672-2446
Mailing Address - Fax:
Practice Address - Street 1:1010 2ND ST
Practice Address - Street 2:APT # 6
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1770
Practice Address - Country:US
Practice Address - Phone:406-672-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker