Provider Demographics
NPI:1659686814
Name:AMMANN, KIMBERLY ANN (LPC-MH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:AMMANN
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 4TH ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1898
Mailing Address - Country:US
Mailing Address - Phone:058-865-2626
Mailing Address - Fax:605-886-5228
Practice Address - Street 1:600 4TH ST NE STE 203
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-886-5262
Practice Address - Fax:605-886-5262
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7344101YP2500X
SD20173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200010Medicaid