Provider Demographics
NPI:1386846376
Name:KIMMELL, DIANE ELAYNE (MSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ELAYNE
Last Name:KIMMELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 YORK ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2157
Mailing Address - Country:US
Mailing Address - Phone:303-388-1034
Mailing Address - Fax:
Practice Address - Street 1:1441 YORK ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2157
Practice Address - Country:US
Practice Address - Phone:303-388-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9861041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical