Individual
MS. KIMBERLY SUE WASOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, LCAC
Contact information
Practice address
3220 E JEFFERSON BLVD, SOUTH BEND, IN 46615-3028
(574) 222-2466
(574) 222-2468
Mailing address
3220 E. JEFFERSON BLVD., SOUTH BEND, IN 46615-2733
(574) 222-2466
(574) 222-2468
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000873A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000542441
UNICARE
IN
05
—
200375890A
—
IN
Enumeration date
11/01/2007
Last updated
07/21/2022
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