Provider Demographics
NPI:1598444812
Name:RODE, KIMBERLY (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RODE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RODE
Other - Last Name:ZUBILLAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:22701 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:KS
Mailing Address - Zip Code:66013-9115
Mailing Address - Country:US
Mailing Address - Phone:913-333-1467
Mailing Address - Fax:
Practice Address - Street 1:22701 METCALF AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:KS
Practice Address - Zip Code:66013-9115
Practice Address - Country:US
Practice Address - Phone:913-333-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker