MEDICARE: KIMBERLY SANDERSON PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1326996091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY SANDERSON PLLC

Provider Business Mailing Address
First Line	:	4494 WARWICK CIRCLE DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8337
Country	:	US
Telephone Number	:	810-955-6081
Fax Number	:

Provider Business Practice Location Address
First Line	:	4494 WARWICK CIRCLE DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8337
Country	:	US
Telephone Number	:	810-955-6081
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL THERAPIST
Name	:	KIMBERLY MARIE SANDERSON
Credential	:	LMSW
Telephone Number	:	810-955-6081

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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