Provider Demographics
NPI:1669299897
Name:MASKER, KIMBERLY A (BSW, CDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MASKER
Suffix:
Gender:F
Credentials:BSW, CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2544
Mailing Address - Country:US
Mailing Address - Phone:304-834-7167
Mailing Address - Fax:
Practice Address - Street 1:1011 28TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-2544
Practice Address - Country:US
Practice Address - Phone:304-834-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency