Provider Demographics
NPI:1912750548
Name:WIMLEY, KATHLEEN PEARL (LSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PEARL
Last Name:WIMLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15592
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-7592
Mailing Address - Country:US
Mailing Address - Phone:267-804-3771
Mailing Address - Fax:
Practice Address - Street 1:150 N RADNOR CHESTER RD STE F200
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5245
Practice Address - Country:US
Practice Address - Phone:610-977-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903004100104100000X
PASW140256104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker