Provider Demographics
NPI:1205167111
Name:KIMMERLY KIEBLER, KERSTEN MARY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KERSTEN
Middle Name:MARY
Last Name:KIMMERLY KIEBLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:KERSTEN
Other - Middle Name:MARY
Other - Last Name:KIMMERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:
Practice Address - Street 1:1151 MICHIGAN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4069
Practice Address - Country:US
Practice Address - Phone:517-333-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862841041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical