KIMBERLY SHADEAN WEDDERBURN (NPI# 1417501347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417501347 |
| Entity Type | Individual |
| Full Name | KIMBERLY SHADEAN WEDDERBURN |
| Credential | CTRS |
| Practice Address |
2200 Hayes St Fl 3 San Francisco CA 94117-1013 |
| Mailing Address |
4418 Continental Way Stockton CA 95207-8930 |
| Practice Telephone | 4157505649 |
| Mailing Telephone | 3058348948 |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-08-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 225800000X | Recreation Therapist | 67715 | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NA | 0000000000 | 01 |
| Street Address |
2200 HAYES ST FL 3 |
| City | SAN FRANCISCO |
| State | CA |
| Zip Code | 94117-1013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497231765 | Tsz Ching Isaac Chung | Counselor | 2020 Hayes Street, San Francisco, CA 94117 | 2018-07-19 |
| 1124578901 | Michelle Elizabeth Cohen | Nurse Practitioner | 350 Parnassus Ave Ste 908, San Francisco, CA 94117 | 2016-10-05 |
| 1235686346 | Amy Burtelow | Massage Therapist | 425 Divisadero Street Suite 300, San Francisco, CA 94117 | 2016-09-07 |
| 1851790430 | Elissa Stevens | Counselor | 1757 Waller Street, San Francisco, CA 94117 | 2014-08-19 |
| 1831508043 | Colmed Laboratories & Radiology | Clinical Medical Laboratory | 560 Haight Street #104, San Francisco, CA 94117 | 2014-08-13 |
| 1972917847 | Radha Yerneni | Internal Medicine | 450 Stanyan St Fl 6, San Francisco, CA 94117 | 2014-06-18 |
| 1811333594 | Julia Wong | Counselor | 425 Divisadero Street, Suite 300, San Francisco, CA 94117 | 2013-05-21 |
| 1740623529 | Cody Elizabeth Berry | Social Worker | 425 Divisadero, Suite 300, San Francisco, CA 94117 | 2013-04-11 |
| 1235471848 | Steven Ryan Vidrine | Psychiatry & Neurology | 350 Parnassus Ave Ste 201, San Francisco, CA 94117 | 2013-03-21 |
| 1699043810 | Podiatry Plan Inc | Podiatrist | 1353b Haight Street, San Francisco, CA 94117 | 2011-12-02 |
| Find all providers in zip 94117 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972104628 | Ann Egan | Counselor | 207 Cole St, San Francisco, CA 94117-1915 | 2020-11-07 |
| 1326654518 | Mina Dailami | Counselor | 45 Adair St Apt A, San Francisco, CA 94103-3699 | 2020-09-22 |
| 1538773841 | Samantha Santamaria | Counselor | 1001 Potrero Ave Rm 7g12, San Francisco, CA 94110-3518 | 2020-09-03 |
| 1659980076 | Claire Katherine Sheeran | Counselor | 1275 34th Ave, San Francisco, CA 94122-1306 | 2020-07-31 |
| 1104434331 | Archana Chatkara Thomas | Counselor | 974 Pine St Apt 9, San Francisco, CA 94108-2928 | 2020-07-14 |
| 1790306157 | Katherine Rose Kaffka | Counselor | 995 Potrero Ave # 220, San Francisco, CA 94110-2859 | 2020-04-27 |
| 1265073811 | Matthew Charles Paden | Counselor | 1801 Vicente St San Francisco, San Francisco, CA 94116-2923 | 2019-10-04 |
| 1801442140 | Danielle Sawicki | Counselor | 4355 Geary Blvd, San Francisco, CA 94118-3003 | 2019-08-13 |
| 1740847250 | Caroline Elson | Counselor | 1440 Steiner St Apt 3, San Francisco, CA 94115-4128 | 2019-05-21 |
| 1609349190 | Ashley Wood | Counselor | 3450 3rd St Bldg 1 Unit 1c, San Francisco, CA 94124-1443 | 2019-01-07 |
| Find all providers in SAN FRANCISCO | ||||
| City | SAN FRANCISCO |
| Zip Code | 94117 |
Please comment or provide details below to improve the information on KIMBERLY SHADEAN WEDDERBURN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.