Provider Demographics
NPI:1174969976
Name:TRUDELL, KIM MERLE (LCSW, SAC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MERLE
Last Name:TRUDELL
Suffix:
Gender:F
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:WITKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2153 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1000
Mailing Address - Country:US
Mailing Address - Phone:608-513-3769
Mailing Address - Fax:
Practice Address - Street 1:2601 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8942
Practice Address - Country:US
Practice Address - Phone:920-540-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical