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General NPI Number Information
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NPI Number | 1568827293
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Entity Type | Individual
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Provider Name | KIMBERLY MATTHIJSSEN MS, LCGC
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Gender | Female
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 3580 JOSEPH SIEWICK DR SUITE LL-005
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City | FAIRFAX
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State | VA
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Zip | 22033-1717
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Country | US
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Telephone | 703-391-4290
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Fax | 703-391-3769
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Provider Business Mailing Address
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Address Line | 3580 JOSEPH SIEWICK DR SUITE LL-005
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City | FAIRFAX
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State | VA
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Zip | 22033-1717
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Country | US
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Telephone |
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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