Provider Demographics
NPI:1164579074
Name:HEDRICK, KIMBERLEE ANN (MSW, LCSW, BCD, CGP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:MSW, LCSW, BCD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2808
Mailing Address - Country:US
Mailing Address - Phone:225-769-7575
Mailing Address - Fax:225-769-4795
Practice Address - Street 1:9229 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2808
Practice Address - Country:US
Practice Address - Phone:225-769-7575
Practice Address - Fax:225-769-4795
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical