MEDICARE: DR. KIMBERLEY LINDA LEDUC

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	103TC0700X	Clinical Psychologist	PSY 19083	CA

General Provider Information

NPI Number	:	1073591707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLEY LINDA LEDUC

Provider Business Mailing Address
First Line	:	28180 SMYTH DR
Second Line	:	SUITE 204
City	:	VALENCIA
State	:	CA
Zip	:	91355-4066
Country	:	US
Telephone Number	:	661-312-8054
Fax Number	:	661-948-3484

Provider Business Practice Location Address
First Line	:	43301 DIVISION ST
Second Line	:	SUITE 104
City	:	LANCASTER
State	:	CA
Zip	:	93535-4647
Country	:	US
Telephone Number	:	661-312-8054
Fax Number	:	661-948-3484

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/03/2009

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