Provider Demographics
NPI:1780254912
Name:SOBON, KIMBERLY LYNNE (LICSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:SOBON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 113TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3766
Mailing Address - Country:US
Mailing Address - Phone:612-483-6452
Mailing Address - Fax:
Practice Address - Street 1:7914 113TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3766
Practice Address - Country:US
Practice Address - Phone:612-483-6452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical