1245471192 NPI number — KIMBERLY A RANDELL-KRONSCHNABEL LMSW

Table of content: KIMBERLY A RANDELL-KRONSCHNABEL LMSW (NPI 1245471192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245471192 NPI number — KIMBERLY A RANDELL-KRONSCHNABEL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDELL-KRONSCHNABEL
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRONSCHNABEL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245471192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855-4630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-233-1236
Provider Business Mailing Address Fax Number:
906-233-1235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-233-1236
Provider Business Practice Location Address Fax Number:
906-233-1235
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801085326 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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