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General NPI Number Information
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NPI Number | 1770853301
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Entity Type | Organization
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Legal Business Name | KIMBERLY D NIELSEN, PLLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 15396 N 83RD AVE STE F101
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City | PEORIA
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State | AZ
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Zip | 85381-5629
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Country | US
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Telephone | 623-640-7940
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Fax |
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Provider Business Mailing Address
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Address Line | 15396 N 83RD AVE STE F101
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City | PEORIA
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State | AZ
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Zip | 85381-5629
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Country | US
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Telephone | 623-640-7940
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Fax |
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Authorized Official
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Title or Position | CHILD AND FAMILY THERAPIST
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Name | MRS. KIMBERLY DAWN NIELSEN
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Credential | LCSW
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Telephone | 623-640-7940
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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 | LCSW1099
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License Number State | AZ
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