Kimberly A Robertson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2023017145 Issued in MO

Practice address

910 E San Martin St Ofc 2
Bolivar, MO 65613-2893

Phone

(417) 414-0676

Fax

(844) 222-4909

NPI assigned

Mar 20, 2021

Last updated

Apr 22, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kimberly A Kanna Former name

Medicare fee-for-service enrollment

Enrolled in MO, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Free Your Mind Therapy LLC

  • Clinical Social Worker
  • Bolivar, MO
  • NPI 1154001469

  CO

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1851977953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1069",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655361069",
            "telephone_number": "855-549-4847",
            "fax_number": "844-222-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 E SAN MARTIN ST OFC 2",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132893",
            "telephone_number": "417-414-0676",
            "fax_number": "844-222-4909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "729 Main St",
            "address_purpose": "LOCATION",
            "city": "Canon City",
            "state": "CO",
            "postal_code": "812123738",
            "country_code": "US",
            "telephone_number": "719-345-2267",
            "fax_number": "844-222-4909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-20",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09929480",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2023017145",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "33114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "KANNA",
            "middle_name": "A",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Revive Medical LLC
• Haris Riaz, M.D.
• Michelle K Rieck, NHA CPH
• Joyce Dianne Ries, LCSW
• Kelly Rinker, SLP
• Matthew Joel Robertson, PTA
• Sandra Robertson
• Brian R Robinson, DO
• David B Rogers, M.D.
• Staci Dawn Rogers, M.D.

• Clinical Social Worker in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.