Provider Demographics
NPI:1639666084
Name:KIMBALL, KRISTEN NICHOLE (MT-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICHOLE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 N THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-8864
Mailing Address - Country:US
Mailing Address - Phone:989-397-4141
Mailing Address - Fax:
Practice Address - Street 1:3054 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9244
Practice Address - Country:US
Practice Address - Phone:989-992-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist