Healthcare Provider Details

I. General information

NPI: 1851054209
Provider Name (Legal Business Name): KIMBRA MARIE BUERSCHAPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 S MAIN ST STE 202
KALISPELL MT
59901-5342
US

IV. Provider business mailing address

PO BOX 10793
KALISPELL MT
59904-3793
US

V. Phone/Fax

Practice location:
  • Phone: 406-356-6496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number54894
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: