Provider Demographics
NPI:1417221516
Name:WALLACE-YOUNG, KIMBERLY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:WALLACE-YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD., MS 2028
Mailing Address - Street 2:UNIVERSITY OF KANSAS MEDICAL CENTER, DEPARTMENT OF OBST
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-945-8800
Mailing Address - Fax:913-588-6271
Practice Address - Street 1:3901 RAINBOW BLVD., MS 2028
Practice Address - Street 2:UNIVERSITY OF KANSAS MEDICAL CENTER, DEPARTMENT OF OBST
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-945-8800
Practice Address - Fax:913-588-6271
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP 1207103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist