Provider Demographics
NPI:1568827293
Name:MATTHIJSSEN, KIMBERLY (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MATTHIJSSEN
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE LL-005
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3580 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE LL-005
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1717
Practice Address - Country:US
Practice Address - Phone:703-391-4290
Practice Address - Fax:703-391-3769
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS