Provider Demographics
NPI:1306822390
Name:DEMPSEY, KIM ANN (PSY D)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ANN
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6723 SAINT TROPEZ CIR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-4005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1197 HIGHWAY KK
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3344
Practice Address - Country:US
Practice Address - Phone:573-348-5331
Practice Address - Fax:573-348-5232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004033754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist