Provider Demographics
NPI:1336378843
Name:SNOW, KIMBERLY N (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:SNOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N MERIDIAN ST # V323
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2695
Mailing Address - Country:US
Mailing Address - Phone:503-544-3529
Mailing Address - Fax:
Practice Address - Street 1:2400 NE LANCASTER DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305
Practice Address - Country:US
Practice Address - Phone:503-588-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health