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General NPI Number Information
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NPI Number | 1720573512
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Entity Type | Organization
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Legal Business Name | KIMBERLY LEDWA, LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2971 E COPPER POINT DR STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-9276
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Country | US
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Telephone | 208-376-5683
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Fax | 208-376-5690
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Provider Business Mailing Address
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Address Line | 2971 E COPPER POINT DR STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-9276
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Country | US
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Telephone | 208-376-5683
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Fax | 208-376-5690
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Authorized Official
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Title or Position | OWNER/COUNSELOR SUPERVISOR
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Name | MS. KIMBERLY O LEDWA
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Credential | LCPC, ACADC
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Telephone | 208-376-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-5328
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License Number State | ID
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