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NPI Code Detail

MEDICARE: MS. KIMBERLY TALLON

MEDICARE: MS. KIMBERLY TALLON
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
1101YM0800XMental Health Counselor093770IA
21041C0700XClinical Social Worker
31041C0700XClinical Social Worker093770IA

General Provider Information

NPI Number : 1740679745
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY TALLON
Provider Business Mailing Address
First Line : 2345 POPLAR ST
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-4136
Country : US
Telephone Number : 515-520-7877
Fax Number :
Provider Business Practice Location Address
First Line : 3375 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-207-8932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2015
Last Update Date : 10/24/2019

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Directions to “ MS. KIMBERLY TALLON ” Practice Location

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