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General NPI Number Information
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NPI Number | 1568384576
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Entity Type | Individual
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Provider Name | KIMBERLY ANN CHURCHILL
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 16154 MAIN AVE SE # 134
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City | PRIOR LAKE
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State | MN
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Zip | 55372-4800
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Country | US
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Telephone | 952-447-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 16209 EVANSTON AVE SE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-2596
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Country | US
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Telephone | 612-209-2796
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13830
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License Number State | MN
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