Provider Demographics
NPI:1760653497
Name:ALDERSON, KIMBERLY (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:ALDERSON
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16162 ELLIS AVE # 1N
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1700
Mailing Address - Country:US
Mailing Address - Phone:708-990-6090
Mailing Address - Fax:708-331-9417
Practice Address - Street 1:16162 ELLIS AVE # 1N
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1700
Practice Address - Country:US
Practice Address - Phone:708-990-6090
Practice Address - Fax:708-331-9417
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006332A1041C0700X
1041C0700X
IL1490102801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty