Basic Information
| Provider Information | |||||||||
| NPI: | 1619326022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOESTER | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | L.M.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15945 CANAL RD | ||||||||
| Address2: | TO | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864162300 | ||||||||
| FaxNumber: | 5864162311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 13TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480606546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109879100 | ||||||||
| FaxNumber: | 8109879105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2016 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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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 | 1041C0700X | SA0740002 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.