Individual
KIMBERLEY IRENE NUSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2502 E FOURTH PLAIN BLVD, VANCOUVER, WA 98661-3965
(360) 831-0904
(360) 433-9917
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
(253) 681-6603
(206) 764-8005
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW61294719
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2115400
—
WA
Enumeration date
10/29/2016
Last updated
09/30/2022
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