Provider Demographics
NPI:1962639385
Name:BALSEMER, KIMBERLY SUZANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:BALSEMER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 SE CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3508
Mailing Address - Country:US
Mailing Address - Phone:360-480-3495
Mailing Address - Fax:
Practice Address - Street 1:2530 NE KRESKY AVE
Practice Address - Street 2:AUITE B
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2406
Practice Address - Country:US
Practice Address - Phone:360-480-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60083779225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist