Provider Demographics
NPI:1912223348
Name:SALMON, KIMBERLY MICHELLE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:SALMON
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 1:214 ESTATES DR STE E
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2353
Mailing Address - Country:US
Mailing Address - Phone:916-581-0054
Mailing Address - Fax:916-244-0252
Practice Address - Street 1:214 ESTATES DR STE E
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2353
Practice Address - Country:US
Practice Address - Phone:916-581-0054
Practice Address - Fax:916-244-0252
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53299101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA474351682Medicaid
CA844879614Medicaid