MS. KIMBERLY SUE WASOSKI LMHC LCAC NPI 1639358161

NPI Information

NPI: 1639358161
Provider Name: MS. KIMBERLY SUE WASOSKI, LMHC, LCAC
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

PECOS Registration: Yes

Address:
3220 E JEFFERSON BLVD
SOUTH BEND, IN
ZIP 46615
Phone: (574) 222-2466
Get Directions

MS. Kimberly Sue Wasoski, LMHC, LCAC is a mental health counselor in South Bend, IN with 36 years of experience. MS. Kimberly Sue Wasoski, LMHC, LCAC NPI is 1639358161. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3220 E JEFFERSON BLVD
SOUTH BEND, IN
ZIP 46615-028
Phone: (574) 222-2466
Fax: (574) 222-2468

The NPI 1639358161 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 11/1/2007 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	39000873A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000542441	OTHER	INDIANA	ANTHEM
2	200375890A	MEDICAID	INDIANA
3	000000542441	OTHER	INDIANA	UNICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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