Provider Demographics
NPI:1578247193
Name:FONTANA, KIMBERLY K (MSCP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E FIREWEED LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2145
Mailing Address - Country:US
Mailing Address - Phone:907-748-8928
Mailing Address - Fax:
Practice Address - Street 1:405 E FIREWEED LN STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2145
Practice Address - Country:US
Practice Address - Phone:907-748-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor