Provider Demographics
NPI:1902928914
Name:ECKERLE, KIM WEBER (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:WEBER
Last Name:ECKERLE
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:WEBER
Other - Last Name:ECKERLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TEACHER
Mailing Address - Street 1:518 S PLATEAU TRL
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1861
Mailing Address - Country:US
Mailing Address - Phone:574-583-4629
Mailing Address - Fax:574-583-4689
Practice Address - Street 1:518 S PLATEAU TRL
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1861
Practice Address - Country:US
Practice Address - Phone:574-583-4629
Practice Address - Fax:574-583-4689
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN735256101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool