Provider Demographics
NPI:1568100204
Name:LEIB, KIMBERLY (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEIB
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 1:2312 N NEVADA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5307
Mailing Address - Country:US
Mailing Address - Phone:719-473-3272
Mailing Address - Fax:
Practice Address - Street 1:2312 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5307
Practice Address - Country:US
Practice Address - Phone:719-473-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5750103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist