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Individual

KIMBERLY JEAN BLOODSWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
10514 RACETRACK RD STE G, BERLIN, MD 21811-3241
(410) 973-2371
Mailing address
10514 RACETRACK RD STE G, BERLIN, MD 21811-3241
(410) 973-2301

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA358
MD
106S00000X
Behavior Technician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
483106300
MD
Enumeration date
05/25/2017
Last updated
11/01/2017
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