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General NPI Number Information
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NPI Number | 1760769657
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Entity Type | Individual
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Provider Name | KIMBERLY KATHRYN CHILDERS M.S., C.G.C.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 181 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4504
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Country | US
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Telephone | 818-748-4762
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Fax | 818-748-4711
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Provider Business Mailing Address
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Address Line | 181 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4504
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Country | US
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Telephone | 818-748-4761
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Fax | 818-748-4711
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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 | 246.000119
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC000547
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License Number State | CA
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