Provider Demographics
NPI:1346602422
Name:NELSON, KIMBERLY (CADC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1614
Mailing Address - Country:US
Mailing Address - Phone:712-423-9098
Mailing Address - Fax:712-423-9604
Practice Address - Street 1:1011 10TH ST
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1614
Practice Address - Country:US
Practice Address - Phone:712-423-9098
Practice Address - Fax:712-423-9604
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11093101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)