Provider Demographics
NPI:1740265222
Name:NEUHARTH, KIMBERLY ANN (MA, MHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:NEUHARTH
Suffix:
Gender:F
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-9768
Mailing Address - Country:US
Mailing Address - Phone:712-243-2606
Mailing Address - Fax:
Practice Address - Street 1:2307 OLIVE ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-9768
Practice Address - Country:US
Practice Address - Phone:712-243-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28764207Q00000X
IA077931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04875OtherWELLMARK BCBS
IA1073403Medicaid
IAI11409Medicare ID - Type Unspecified
IA1073403Medicaid