Provider Demographics
NPI:1821472655
Name:KIMBALL, SHARI K (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:K
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KIMBALL
Other - Last Name:AMIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1185 HIGHWAY 412 W
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4551
Mailing Address - Country:US
Mailing Address - Phone:479-599-9603
Mailing Address - Fax:
Practice Address - Street 1:1185 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4551
Practice Address - Country:US
Practice Address - Phone:479-373-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR111915-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13281Medicaid