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General NPI Number Information
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NPI Number | 1407170046
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Entity Type | Individual
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Provider Name | KIMBERLY ANN WALDRON PSY.D
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Gender | Female
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 1463 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2653
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Country | US
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Telephone | 248-414-3382
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Fax | 248-414-3385
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Provider Business Mailing Address
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Address Line | 1463 E. 12 MILE RD.
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071
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Country | US
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Telephone | 248-414-3382
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Fax | 248-414-3385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301013137
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License Number State | MI
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