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General NPI Number Information
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NPI Number | 1407262801
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Entity Type | Individual
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Provider Name | KIMBERLY DETERDING LAC; LMT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 111 1ST ST E
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City | INDEPENDENCE
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State | IA
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Zip | 50644-2806
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Country | US
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Telephone | 319-231-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 3336 KIMBALL AVE STE 150B
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City | WATERLOO
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State | IA
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Zip | 50702-5762
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Country | US
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Telephone | 319-231-9545
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | A-138
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 007159
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License Number State | IA
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