Provider Demographics
NPI:1811523525
Name:WILHELMY, KYMBERLEIGH NICOLE
Entity type:Individual
Prefix:MRS
First Name:KYMBERLEIGH
Middle Name:NICOLE
Last Name:WILHELMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1122
Mailing Address - Country:US
Mailing Address - Phone:612-872-8218
Mailing Address - Fax:612-874-8885
Practice Address - Street 1:2712 FREMONT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1122
Practice Address - Country:US
Practice Address - Phone:612-872-8218
Practice Address - Fax:612-874-8885
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherI DO NOT HAVE THIS INFORMATION