Provider Demographics
NPI:1861834194
Name:HILL GRUNDMAN, KIMBERLY MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:HILL GRUNDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:NE
Mailing Address - Zip Code:68358-6025
Mailing Address - Country:US
Mailing Address - Phone:402-802-0818
Mailing Address - Fax:402-205-1180
Practice Address - Street 1:108 W 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:NE
Practice Address - Zip Code:68358-6025
Practice Address - Country:US
Practice Address - Phone:402-802-0818
Practice Address - Fax:402-205-1180
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE902103TC2200X
46863103TS0200X
NE513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026172100Medicaid