Provider Demographics
NPI:1114178068
Name:KLINE, KIM-SANDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM-SANDY
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 E PALMER WASILLA HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7752
Mailing Address - Country:US
Mailing Address - Phone:907-982-2146
Mailing Address - Fax:
Practice Address - Street 1:4900 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7752
Practice Address - Country:US
Practice Address - Phone:907-982-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical