MEDICARE: KIMBERLEE ANN COMFORT MA, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP3043	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	58053	OTHER	MN	HEALTHPARTNERS
3	62-68366	OTHER	MN	UNITED BEHAVIORAL HEALTH - UBH

General Provider Information

NPI Number	:	1033354154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE ANN COMFORT MA, LP

Provider Business Mailing Address
First Line	:	1405 SILVER LAKE RD NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9301
Country	:	US
Telephone Number	:	651-633-4532
Fax Number	:	651-633-9311

Provider Business Practice Location Address
First Line	:	1405 SILVER LAKE RD NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9301
Country	:	US
Telephone Number	:	651-633-4532
Fax Number	:	651-633-9311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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Directions to “ KIMBERLEE ANN COMFORT MA, LP” Practice Location

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