Provider Demographics
NPI:1639550536
Name:GILBERT, KIMBERLY JEANNE (MBA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEANNE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S ASSEMBLY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-2116
Mailing Address - Country:US
Mailing Address - Phone:509-892-9241
Mailing Address - Fax:509-892-9251
Practice Address - Street 1:1700 S ASSEMBLY RD STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-2116
Practice Address - Country:US
Practice Address - Phone:509-892-9241
Practice Address - Fax:509-892-9251
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV88-66000022Medicaid