Provider Demographics
NPI:1245471192
Name:RANDELL-KRONSCHNABEL, KIMBERLY A (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:RANDELL-KRONSCHNABEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KRONSCHNABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4630
Mailing Address - Country:US
Mailing Address - Phone:906-233-1236
Mailing Address - Fax:906-233-1235
Practice Address - Street 1:200 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4630
Practice Address - Country:US
Practice Address - Phone:906-233-1236
Practice Address - Fax:906-233-1235
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010853261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical