MEDICARE: KIMBERLEY M CLOUGH

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	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912632357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY M CLOUGH

Provider Business Mailing Address
First Line	:	2675 E 130TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1451
Country	:	US
Telephone Number	:	937-902-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	6854 SAVANNAH DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2930
Country	:	US
Telephone Number	:	440-219-4135
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	04/06/2026

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Directions to “ KIMBERLEY M CLOUGH ” Practice Location

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