MEDICARE: KIMBERLY S CADWALLADER LMHC

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306101530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY S CADWALLADER LMHC

Provider Business Mailing Address
First Line	:	2330 EASTGATE ST
Second Line	:	STE 201
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2557
Country	:	US
Telephone Number	:	509-593-9667
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 EASTGATE ST
Second Line	:	STE 201
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2557
Country	:	US
Telephone Number	:	509-593-9667
Fax Number	:

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

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	10/28/2017

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