Basic Information
| Provider Information | |||||||||
| NPI: | 1396006417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 VISTA DEL RANCHO PKWY | ||||||||
| Address2: | APT212 | ||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894366335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756889360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 HARVARD WAY | ||||||||
| Address2: | 105B | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895024002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754205396 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 06/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.