Provider Demographics
NPI:1114221926
Name:KANDEE KUBAT TIMMERMAN, MSW, LICSW, LLC
Entity Type:Organization
Organization Name:KANDEE KUBAT TIMMERMAN, MSW, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KANDEE
Authorized Official - Middle Name:KUBAT
Authorized Official - Last Name:TIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-251-1753
Mailing Address - Street 1:745 GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4245
Mailing Address - Country:US
Mailing Address - Phone:612-251-1753
Mailing Address - Fax:
Practice Address - Street 1:745 GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4245
Practice Address - Country:US
Practice Address - Phone:612-251-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15043251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health