Individual
KIMBERLEY ANN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(508) 736-5699
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(508) 736-5699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113741
MA
Other
Enumeration date
01/23/2009
Last updated
01/23/2009
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