Provider Demographics
NPI:1871230086
Name:KIMBERLY DAGLEN, LLC
Entity Type:Organization
Organization Name:KIMBERLY DAGLEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:DAGLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:208-515-1988
Mailing Address - Street 1:6955 N MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5423
Mailing Address - Country:US
Mailing Address - Phone:208-515-1988
Mailing Address - Fax:
Practice Address - Street 1:6955 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5423
Practice Address - Country:US
Practice Address - Phone:208-515-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty