MEDICARE: KIM YKEMA COUNSELING 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	:	1699328153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM YKEMA COUNSELING PLLC

Provider Business Mailing Address
First Line	:	908 GEORGIANA ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3912
Country	:	US
Telephone Number	:	360-504-3784
Fax Number	:	360-504-3984

Provider Business Practice Location Address
First Line	:	908 GEORGIANA ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3912
Country	:	US
Telephone Number	:	360-504-3784
Fax Number	:	360-504-3984

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLE JEANNE YKEMA
Credential	:	LICSW
Telephone Number	:	360-504-3784

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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