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General NPI Number Information
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NPI Number | 1952212516
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Entity Type | Individual
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Provider Name | KIMBERLY MARY FLOOR LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 9964 GAST RD
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City | BRIDGMAN
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State | MI
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Zip | 49106-9750
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Country | US
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Telephone | 269-466-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 6603 LIGHTHOUSE DR APT 204
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City | PORTAGE
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State | IN
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Zip | 46368-6909
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Country | US
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Telephone | 219-427-7515
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801120578
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License Number State | MI
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