Provider Demographics
NPI:1033596879
Name:STEWART, KIMBERLY DAWN (PHD, LP, LAMFT)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD, LP, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 POWDERHORN TER APT 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1649
Mailing Address - Country:US
Mailing Address - Phone:612-812-0992
Mailing Address - Fax:
Practice Address - Street 1:2626 E 82ND ST STE 225B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1301
Practice Address - Country:US
Practice Address - Phone:612-812-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6856103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist