Provider Demographics
NPI:1780158477
Name:LEIGHTON, KIMBERLY R (CCLS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MIDDLE RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009
Mailing Address - Country:US
Mailing Address - Phone:207-329-5545
Mailing Address - Fax:
Practice Address - Street 1:278 MIDDLE RIDGE RD.
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-329-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1129064222Q00000X, 251G00000X, 253Z00000X, 374J00000X, 385H00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No374J00000XNursing Service Related ProvidersDoula
No385H00000XRespite Care FacilityRespite Care