Provider Demographics
NPI:1851977953
Name:KANNA, KIMBERLY A (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:KANNA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW & MSW, LSW
Mailing Address - Street 1:910 E SAN MARTIN ST OFC 2
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2893
Mailing Address - Country:US
Mailing Address - Phone:417-414-0676
Mailing Address - Fax:844-222-4909
Practice Address - Street 1:910 E SAN MARTIN ST OFC 2
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2893
Practice Address - Country:US
Practice Address - Phone:417-414-0676
Practice Address - Fax:844-222-4909
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099294801041C0700X
MO20230171451041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty