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General NPI Number Information
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NPI Number | 1669672515
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Entity Type | Individual
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Provider Name | CATHERINE LEA KIMBALL MSW, LICSWA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 105B W MAIN STE 113
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City | PUYALLUP
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State | WA
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Zip | 98371-5329
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Country | US
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Telephone | 253-222-2988
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1522
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City | ORTING
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State | WA
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Zip | 98360-1522
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Country | US
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Telephone | 253-222-2988
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60995790
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License Number State | WA
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