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Individual
KIMBERLY SHADEAN WEDDERBURN
Active
Individual
KIMBERLY SHADEAN WEDDERBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
225800000X
Recreation Therapist
67715
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000
NA
—
Enumeration date
07/29/2019
Last updated
08/07/2019
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