Provider Demographics
NPI:1881363703
Name:KIDNEIGH, TIMOTHY MIKEAL
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MIKEAL
Last Name:KIDNEIGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W K ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2944
Mailing Address - Country:US
Mailing Address - Phone:360-426-1696
Mailing Address - Fax:
Practice Address - Street 1:110 W K ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2944
Practice Address - Country:US
Practice Address - Phone:360-426-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor