Most Relevant Information
Provider Data
| NPI Number: | 1003537515 |
| Provider Name: | KIMBERLY EVETTE HEARON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 87000043A |
Most Important Dates
| Enumeration Date: | 09/05/2022 |
| Last Updated: | 09/05/2022 |
Provider Practice Location
5971 WINCHESTER PL
PORTAGE
IN
463684915
Practice Location Phone/Fax
| Phone: | 2192010716 |
| Fax: |
Provider Mailing Location
5971 WINCHESTER PL
PORTAGE
IN
463684915
Provider Mailing Phone/Fax
| Phone: | 2192010716 |
| Fax: |