Provider Demographics
NPI:1457505661
Name:WEIDEMAIER-KITSON, KELLY L (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:WEIDEMAIER-KITSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 BLUEWING WAY
Mailing Address - Street 2:
Mailing Address - City:WASHOE VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89704-9067
Mailing Address - Country:US
Mailing Address - Phone:775-843-1100
Mailing Address - Fax:
Practice Address - Street 1:180 W HUFFAKER LN
Practice Address - Street 2:#303
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2346
Practice Address - Country:US
Practice Address - Phone:775-843-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist