MEDICARE: KIMBERLY CORDERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LMSW-28608	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558817981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CORDERO

Provider Business Mailing Address
First Line	:	13213 N DECHAMBEAU WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83714-9429
Country	:	US
Telephone Number	:	208-906-3644
Fax Number	:	208-493-4331

Provider Business Practice Location Address
First Line	:	533 E RIVERSIDE DR STE 120
Second Line	:
City	:	EAGLE
State	:	ID
Zip	:	83616-6585
Country	:	US
Telephone Number	:	208-906-3644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	12/18/2025

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Directions to “ KIMBERLY CORDERO ” Practice Location

Language	Start Address	Practice Location

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