Healthcare Provider Details

I. General information

NPI: 1407201130
Provider Name (Legal Business Name): KIMBERLEY BJORN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N 2ND ST
TACOMA WA
98403-2232
US

IV. Provider business mailing address

13201 130TH STREET KP N
GIG HARBOR WA
98329-5141
US

V. Phone/Fax

Practice location:
  • Phone: 253-208-3526
  • Fax:
Mailing address:
  • Phone: 253-208-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60043468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: