Individual
KIMBERLY ILVENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPS
Contact information
Practice address
1735 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-3718
(530) 541-4111
Mailing address
1735 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-3718
(530) 541-4111
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
—
Other
Enumeration date
01/10/2025
Last updated
01/10/2025
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