Individual
EDWARD JOSEPH KIMMEL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
480 EVERSMAN DRIVE, JASPER, IN 47547-0769
(812) 482-3020
(812) 482-6409
Mailing address
PO BOX 769, 480 EVERSMAN DRIVE, JASPER, IN 47547-0769
(812) 482-3020
(812) 482-6409
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001093A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108710A
—
IN
Enumeration date
05/20/2009
Last updated
05/20/2009
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