Individual
KIMBERLY DIANNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
6601 SW 9TH ST, DES MOINES, IA 50315-6138
(515) 643-8350
(515) 643-5824
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-8350
(515) 643-5824
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
06171
IA
1041C0700X
Clinical Social Worker
Primary
06171
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982657490
—
IA
Enumeration date
05/24/2017
Last updated
12/27/2024
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