Provider Demographics
NPI:1407204977
Name:PULLOM, KIMBERLY (LSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PULLOM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20068
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-0068
Mailing Address - Country:US
Mailing Address - Phone:419-531-5544
Mailing Address - Fax:
Practice Address - Street 1:5301 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4632
Practice Address - Country:US
Practice Address - Phone:419-531-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.15025691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical