Provider Demographics
NPI:1730678095
Name:WHITEMAN, KIMBERLY JO
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:WHITEMAN
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 1:4246 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9744
Mailing Address - Country:US
Mailing Address - Phone:440-669-5222
Mailing Address - Fax:
Practice Address - Street 1:4246 HARPER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9744
Practice Address - Country:US
Practice Address - Phone:440-669-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)