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NPI Code Detail

MEDICARE: MS. KIMBERLY SUE VANCE MASTER OF EDUCATION

MEDICARE: MS. KIMBERLY SUE VANCE MASTER OF EDUCATION
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
1101Y00000XCounselor39001136AIN
2101YM0800XMental Health Counselor39001136AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000341223OTHERINANTHEM
27381710OTHERINAETNA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4793356000OTHERINMAGELLAN

General Provider Information

NPI Number : 1538230123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY SUE VANCE MASTER OF EDUCATION
Provider Business Mailing Address
First Line : 17195 CLEVELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1415
Country : US
Telephone Number : 574-277-0274
Fax Number : 574-271-7202
Provider Business Practice Location Address
First Line : 17195 CLEVELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1415
Country : US
Telephone Number : 574-277-0274
Fax Number : 574-271-7202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 05/17/2024

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Directions to “ MS. KIMBERLY SUE VANCE MASTER OF EDUCATION” Practice Location

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