Provider Demographics
NPI:1821564618
Name:RAHN, KIMBERLY K
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:RAHN
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 1:2075 N STATE ROUTE 115
Mailing Address - Street 2:
Mailing Address - City:THAWVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60968-9745
Mailing Address - Country:US
Mailing Address - Phone:815-383-2651
Mailing Address - Fax:
Practice Address - Street 1:2075 N STATE ROUTE 115
Practice Address - Street 2:
Practice Address - City:THAWVILLE
Practice Address - State:IL
Practice Address - Zip Code:60968-9745
Practice Address - Country:US
Practice Address - Phone:815-383-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist