Provider Demographics
NPI:1417234220
Name:SHINGLES, KIMBERLY R (LSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:SHINGLES
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 1:351 COMMON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6142
Mailing Address - Country:US
Mailing Address - Phone:702-459-0281
Mailing Address - Fax:
Practice Address - Street 1:351 COMMON CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6142
Practice Address - Country:US
Practice Address - Phone:702-459-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6089-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker