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NPI Code Detail

MEDICARE: KIMBERLY BETH DIEBBOLL M.A., LLP

MEDICARE: KIMBERLY BETH DIEBBOLL M.A., LLP
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
1103TC0700XClinical Psychologist6301011139MI
2103TC0700XClinical Psychologist6361005209MI

General Provider Information

NPI Number : 1982879318
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY BETH DIEBBOLL M.A., LLP
Provider Business Mailing Address
First Line : 555 TOWNER ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-5723
Country : US
Telephone Number : 734-544-3000
Fax Number : 734-544-6716
Provider Business Practice Location Address
First Line : 555 TOWNER ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-5723
Country : US
Telephone Number : 734-544-3000
Fax Number : 734-544-6716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2008
Last Update Date : 02/10/2022

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