Provider Demographics
NPI:1649585928
Name:MARTUS, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MARTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9653
Mailing Address - Country:US
Mailing Address - Phone:517-331-4664
Mailing Address - Fax:
Practice Address - Street 1:120 W EXCHANGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2834
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical