Provider Demographics
NPI:1811270168
Name:ZIMBELMAN, KIRK KARL (PH,D,)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:KARL
Last Name:ZIMBELMAN
Suffix:
Gender:M
Credentials:PH,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 23RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-1216
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:904 W 23RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1216
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical