Healthcare Provider Details

I. General information

NPI: 1427911262
Provider Name (Legal Business Name): KIMBERLY DAWN EARL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST STE 125A
SPOKANE WA
99202-4881
US

IV. Provider business mailing address

104 S FREYA ST STE 125A
SPOKANE WA
99202-4881
US

V. Phone/Fax

Practice location:
  • Phone: 509-904-5230
  • Fax:
Mailing address:
  • Phone: 509-904-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61350764
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: