Provider Demographics
NPI:1508098518
Name:KIMBALL, MERIKAY
Entity Type:Individual
Prefix:MS
First Name:MERIKAY
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 SHERMAN AVE
Mailing Address - Street 2:SUITE NUMBER 202
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3798
Mailing Address - Country:US
Mailing Address - Phone:847-866-7545
Mailing Address - Fax:
Practice Address - Street 1:1830 SHERMAN AVE
Practice Address - Street 2:SUITE NUMBER 202
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3798
Practice Address - Country:US
Practice Address - Phone:847-866-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional