1942371307 NPI number — MS. KIMBERLEE A KALI-SCHULTES LCSW/LISW

Table of content: MS. KIMBERLEE A KALI-SCHULTES LCSW/LISW (NPI 1942371307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942371307 NPI number — MS. KIMBERLEE A KALI-SCHULTES LCSW/LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALI-SCHULTES
Provider First Name:
KIMBERLEE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW/LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLUESNER
Provider Other First Name:
KIM
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW/LISW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942371307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3086
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52004-3086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-213-8502
Provider Business Mailing Address Fax Number:
877-836-1290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 DAVIS ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52001-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-213-8502
Provider Business Practice Location Address Fax Number:
877-836-1290
Provider Enumeration Date:
11/09/2006

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: 1041C0700X , with the licence number:  149.011638 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 06812 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06812 . This is a "LICENSED INDEPENDENT SW" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: K37268 . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 149.011638 . This is a "LICENSED CLINICAL SW" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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