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NPI Code Detail

MEDICARE: KIMBERLY WIRTH MSW,LCSW

MEDICARE: KIMBERLY WIRTH MSW,LCSW
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
11041C0700XClinical Social Worker149.031431IL

General Provider Information

NPI Number : 1790188100
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY WIRTH MSW,LCSW
Provider Business Mailing Address
First Line : 902 W MAIN ST
Second Line :
City : WEST FRANKFORT
State : IL
Zip : 62896-2210
Country : US
Telephone Number : 618-326-2772
Fax Number : 618-937-1440
Provider Business Practice Location Address
First Line : 2615 EDWARDS ST
Second Line :
City : ALTON
State : IL
Zip : 62002-3915
Country : US
Telephone Number : 618-462-2331
Fax Number : 618-462-2504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2014
Last Update Date : 03/03/2026

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