Healthcare Provider Details

I. General information

NPI: 1720123375
Provider Name (Legal Business Name): KIMBERLY SUE VENTEICHER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 18TH ST
ESTHERVILLE IA
51334-2721
US

IV. Provider business mailing address

300 S 18TH ST
ESTHERVILLE IA
51334-2721
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-8348
  • Fax:
Mailing address:
  • Phone: 712-362-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number084112
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: