Basic Information
| Provider Information | |||||||||
| NPI: | 1427630193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELSH | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 W STATE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611011117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159698836 | ||||||||
| FaxNumber: | 8159698871 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 W STATE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611011117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159698836 | ||||||||
| FaxNumber: | 8159698871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2021 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.020334 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.