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General NPI Number Information
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NPI Number | 1922301258
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Entity Type | Individual
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Provider Name | KIMBERLEY R MONDEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 909 FULTON ST SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-4800
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Country | US
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Telephone | 612-672-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 909 N WASHINGTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-1520
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Country | US
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Telephone | 214-820-9315
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP6576
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0004537
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License Number State | CO
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