Kimberly Shadean Wedderburn, CTRS

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

2200 Hayes St FL 3
San Francisco, CA 94117-1013

Phone

(415) 750-5649

NPI assigned

Jul 29, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1417501347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4418 CONTINENTAL WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952078930",
            "telephone_number": "305-834-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HAYES ST FL 3",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171013",
            "telephone_number": "415-750-5649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDERBURN",
        "first_name": "KIMBERLY",
        "middle_name": "SHADEAN",
        "credential": "CTRS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-29",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "FL",
            "license": "67715",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "0000000000",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "NA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "2200 Hayes St Fl 3",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941171013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Toshia Webster
• Wecare Medbill, Inc.
• Mariano Wechsler
• Nancy Susan Wecker, PH.D.
• Ariana Weckstein
• Charles Maxwell Weddington, M.D.
• Joel A Weddington, MD
• Renee Esther Wedell, BCBA
• Michelle Ariana Wedemeyer, MD, PHD
• Kenneth K Wee, D.M.D.

• Counselor in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.