Provider Demographics
NPI:1073591707
Name:LEDUC, KIMBERLEY LINDA
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:LINDA
Last Name:LEDUC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28180 SMYTH DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4066
Mailing Address - Country:US
Mailing Address - Phone:661-312-8054
Mailing Address - Fax:661-948-3484
Practice Address - Street 1:43301 DIVISION ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4647
Practice Address - Country:US
Practice Address - Phone:661-312-8054
Practice Address - Fax:661-948-3484
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19083Medicare UPIN