Provider Demographics
NPI:1508358037
Name:MONROE, KIMBERLY ANNE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MONROE
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 1:5413 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3929
Mailing Address - Country:US
Mailing Address - Phone:406-899-3566
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 518
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3288
Practice Address - Country:US
Practice Address - Phone:406-899-3566
Practice Address - Fax:406-545-2276
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBHSWLCLIC539181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty