Organization
KIMBERLY D NIELSEN, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY DAWN NIELSEN LCSW (CHILD AND FAMILY THERAPIST)
(623) 640-7940
Entity
Organization
Contact information
Practice address
15396 N 83RD AVE STE F101, PEORIA, AZ 85381-5629
(623) 640-7940
Mailing address
15396 N 83RD AVE STE F101, PEORIA, AZ 85381-5629
(623) 640-7940
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW1099
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922143833
INDIVIDUAL
AZ
Enumeration date
01/12/2012
Last updated
01/12/2012
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