Provider Demographics
NPI:1982809448
Name:KAMMERAAD, KIMBERLY (MA LMHC NBCC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:KAMMERAAD
Suffix:
Gender:F
Credentials:MA LMHC NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FIR PARK LN
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6835
Mailing Address - Country:US
Mailing Address - Phone:253-380-3845
Mailing Address - Fax:253-473-0474
Practice Address - Street 1:5423 S. 54TH
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-380-3845
Practice Address - Fax:360-373-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010825101YM0800X
WALH 00010825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health