Provider Demographics
NPI:1619326022
Name:KOESTER, KIMBERLY (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:KOESTER
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 1:15945 CANAL RD
Mailing Address - Street 2:TO
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1610
Mailing Address - Country:US
Mailing Address - Phone:586-416-2300
Mailing Address - Fax:586-416-2311
Practice Address - Street 1:2601 13TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6546
Practice Address - Country:US
Practice Address - Phone:810-987-9100
Practice Address - Fax:810-987-9105
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA07400021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical