Healthcare Provider Details

I. General information

NPI: 1609641364
Provider Name (Legal Business Name): KIMBERLY CONN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 AUBURN BLVD STE 3
CITRUS HEIGHTS CA
95610-0391
US

IV. Provider business mailing address

4909 DOUVAN CT
CARMICHAEL CA
95608-4107
US

V. Phone/Fax

Practice location:
  • Phone: 916-344-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: