Provider Demographics
NPI:1801353875
Name:SUDERMAN, KIMBERLY RAE (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:SUDERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2209
Mailing Address - Country:US
Mailing Address - Phone:785-560-3101
Mailing Address - Fax:785-527-8317
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:785-587-4300
Practice Address - Fax:785-527-8317
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker