Provider Demographics
NPI:1073635272
Name:BURDICK, KIMBERLY TINSLEY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TINSLEY
Last Name:BURDICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:TINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1240 W SANILAC RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-9654
Mailing Address - Country:US
Mailing Address - Phone:810-648-3248
Mailing Address - Fax:810-648-3907
Practice Address - Street 1:1240 WEST SANILAC RD
Practice Address - Street 2:SUITE D
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-9654
Practice Address - Country:US
Practice Address - Phone:810-648-3248
Practice Address - Fax:810-648-3907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010653331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical