Basic Information
| Provider Information | |||||||||
| NPI: | 1457650020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DREHER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 FORESTVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441163303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409349930 | ||||||||
| FaxNumber: | 4409349645 | ||||||||
| Practice Location | |||||||||
| Address1: | 5255 N ABBE RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440351451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409349930 | ||||||||
| FaxNumber: | 4409349645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2011 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | S.0020766 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | S.0020766 | 01 | OH | STATE OF OHIO COUNSELOR AND SOCIAL WORKER BOARD, MARRIAGE AND FAMILY THERAPIST B | OTHER |