1598774325 NPI number — MRS. KIMBERLEE ANN ANDERSON LCPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598774325 NPI number — MRS. KIMBERLEE ANN ANDERSON LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
KIMBERLEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
KIMBERLEE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598774325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3135 CEMETERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLSTADT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62260-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-538-5728
Provider Business Mailing Address Fax Number:
618-394-5909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8601 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62223-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-394-5900
Provider Business Practice Location Address Fax Number:
618-394-5909
Provider Enumeration Date:
08/08/2006

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: 101YP2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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