Provider Demographics
NPI:1558874578
Name:KIMBLE, RACHEL NELLORA (BA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NELLORA
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2623
Mailing Address - Country:US
Mailing Address - Phone:319-753-6567
Mailing Address - Fax:319-753-0703
Practice Address - Street 1:1340 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2623
Practice Address - Country:US
Practice Address - Phone:319-753-6567
Practice Address - Fax:319-753-0703
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)