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General NPI Number Information
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NPI Number | 1558817981
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Entity Type | Individual
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Provider Name | KIMBERLY CORDERO
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Gender | Female
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 533 E RIVERSIDE DR STE 120
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City | EAGLE
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State | ID
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Zip | 83616-6585
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Country | US
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Telephone | 208-906-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 13213 N DECHAMBEAU WAY
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City | BOISE
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State | ID
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Zip | 83714-9429
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Country | US
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Telephone | 208-906-3644
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Fax | 208-493-4331
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-28608
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License Number State | ID
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