Healthcare Provider Details

I. General information

NPI: 1710808068
Provider Name (Legal Business Name): KIMBERLY ANNE SPERL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N ARTHUR AVE STE 203
POCATELLO ID
83204-3105
US

IV. Provider business mailing address

2227 POCATELLO CREEK RD APT C
POCATELLO ID
83201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 208-234-4673
  • Fax:
Mailing address:
  • Phone: 208-589-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7571995
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: