Provider Demographics
NPI:1992959548
Name:BAKONDI, KIMBERLY L (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:BAKONDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W 1ST ST APT A
Mailing Address - Street 2:
Mailing Address - City:HALSEY
Mailing Address - State:OR
Mailing Address - Zip Code:97348-9677
Mailing Address - Country:US
Mailing Address - Phone:541-829-3537
Mailing Address - Fax:
Practice Address - Street 1:611 W 1ST ST
Practice Address - Street 2:
Practice Address - City:HALSEY
Practice Address - State:OR
Practice Address - Zip Code:97348-9676
Practice Address - Country:US
Practice Address - Phone:541-829-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL81191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical