Provider Demographics
NPI:1437587615
Name:LANNI, KIMBERLY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:LANNI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7973
Mailing Address - Country:US
Mailing Address - Phone:916-789-7082
Mailing Address - Fax:916-797-8840
Practice Address - Street 1:1891 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7973
Practice Address - Country:US
Practice Address - Phone:916-789-7982
Practice Address - Fax:916-797-8840
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25630103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist