Basic Information
| Provider Information | |||||||||
| NPI: | 1447989736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REISER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 BARBERRY DR | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675023300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202004862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 N LORRAINE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675015600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206637595 | ||||||||
| FaxNumber: | 6205135098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2022 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 12630 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.