Provider Demographics
NPI:1083680870
Name:CHUPURDIA, KIMBERLY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:CHUPURDIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2808
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-2800
Mailing Address - Country:US
Mailing Address - Phone:509-688-6700
Mailing Address - Fax:509-688-6777
Practice Address - Street 1:546 N JEFFERSON LN
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7103
Practice Address - Country:US
Practice Address - Phone:509-688-6700
Practice Address - Fax:509-455-6913
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154414761OtherORGANIZATION NPI NUMBER