Provider Demographics
NPI:1700054871
Name:VADNER, KIMBERLY FRANCES (BA, CADC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FRANCES
Last Name:VADNER
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1600
Mailing Address - Country:US
Mailing Address - Phone:630-801-1669
Mailing Address - Fax:630-801-1675
Practice Address - Street 1:108 JOHN ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1600
Practice Address - Country:US
Practice Address - Phone:630-801-1669
Practice Address - Fax:630-801-1675
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6460OtherCADC CERTIFICATE