Provider Demographics
NPI:1154641264
Name:BIRD, KIMBERLEE MARIE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:MARIE
Last Name:BIRD
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 1:24 E 1100 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6333
Mailing Address - Country:US
Mailing Address - Phone:801-837-2594
Mailing Address - Fax:
Practice Address - Street 1:24 E 1100 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6333
Practice Address - Country:US
Practice Address - Phone:801-837-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor