MEDICARE: TREY NED KIMBALL CSW

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	14230062-3502	UT

General Provider Information

NPI Number	:	1558293845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREY NED KIMBALL CSW

Provider Business Mailing Address
First Line	:	PO BOX 184
Second Line	:
City	:	GUNNISON
State	:	UT
Zip	:	84634-0184
Country	:	US
Telephone Number	:	435-406-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 E 700 S
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627
Country	:	US
Telephone Number	:	435-406-9188
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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