Provider Demographics
NPI:1609089820
Name:REZARCH, KIMBERLY NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:REZARCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:KELLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50134-0273
Mailing Address - Country:US
Mailing Address - Phone:515-291-0254
Mailing Address - Fax:
Practice Address - Street 1:804 KELLOGG AVE
Practice Address - Street 2:YOUTH RECOVERY HOUSE
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6234
Practice Address - Country:US
Practice Address - Phone:515-233-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker