JACQUELYN R KIMBALL (Credential# 1128974) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
JACQUELYN R KIMBALL is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.051632. The credential type is physician/surgeon. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 151 Fred Jackson Rd, Southwick, MA 01077-9712. The current status is active.
| Licensee Name | JACQUELYN R KIMBALL |
| Credential ID | 1128974 |
| Credential Number | 1.051632 |
| Credential Type | Physician/Surgeon |
| Business Address |
151 Fred Jackson Rd Southwick MA 01077-9712 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2013-02-07 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-03-09 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 537256 | CSP.0045791 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2009-07-27 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 151 FRED JACKSON RD |
| City | SOUTHWICK |
| State | MA |
| Zip Code | 01077-9712 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kevin M Solek | 230 Granville Road, Southwick, MA 01077-9712 | Plumbing & Piping Limited Journeyperson | 2019-11-01 ~ 2020-10-31 |
| Brian E Drenen · Southwick Builders | 104 Fred Jackson Rd, Southwick, MA 01077-9712 | Home Improvement Contractor | 2018-03-16 ~ 2018-11-30 |
| Talia Diane Barlar | 153 Fred Jackson Rd, Southwick, MA 01077-9712 | Registered Nurse | 2019-06-01 ~ 2020-05-31 |
| Michele C Urban | 155 Fred Jackson Rd, Southwick, MA 01077-9712 | Registered Nurse | 2016-07-01 ~ 2017-06-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth C Levite | 5 Liquori Drive, Southwick, MA 01077 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Nancy M Psholka | 11 Pearlbrook Rd, Southwick, MA 01077 | Physical Therapist | 2020-09-01 ~ 2021-08-31 |
| Diane M Wolfe | 7 Coes Hill Road, Southwick, MA 01077 | Notary Public Appointment | 2020-06-01 ~ 2025-05-31 |
| Donna Glembocki | 12 Berkshire Avenue, Southwick, MA 01077 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Donna L Hawkins | 173 Vining Hill Rd, Southwick, MA 01077 | Licensed Practical Nurse | 2020-09-01 ~ 2021-08-31 |
| Colleen C Dell | 4 Hillcrest Rd, Southwick, MA 01077 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Alla Burkovskiy | 15 Overlook Lane, Southwick, MA 01077 | Real Estate Salesperson | 2019-12-13 ~ 2020-05-31 |
| Tegan M Kimball | 32 Deer Run, Southwick, MA 01077 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Donna P Davis · Bleau | 10 Gloria Drive, Southwick, MA 01077 | Massage Therapist | 2020-06-01 ~ 2022-05-31 |
| Heidi A Kingsley · Card | 13 John Mason Rd., Southwick, MA 01077 | Dental Hygienist | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 01077 | |||
| City | SOUTHWICK |
| Zip Code | 01077 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + SOUTHWICK |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ann Farrell Md | Day Kimball Hospital, Putnam, CT 06260 | Physician/surgeon | 1998-05-29 ~ 1999-06-30 |
| Harlan R Daman | 769 Kimball Ave, Yonkers, NY 10704 | Physician/surgeon | 2006-09-18 ~ 2007-11-30 |
| Boris Konnikow Md | Day Kimball Hospital, Putnam, CT 06260-1868 | Physician/surgeon | 1999-01-19 ~ 2000-02-29 |
| Paul Y Wong Md | Day Kimball Hospital, Putnam, CT 06260 | Physician/surgeon | 2005-04-28 ~ 2006-05-31 |
| Wael F Al-husami | 6 Kimball Court, Woburn, MA 01801 | Physician/surgeon | 2009-04-22 ~ 2009-11-30 |
| Alexander Paul Briand | 7 Kimball St Apt 34, Lebanon, NH 03766-1736 | Physician/surgeon | 2020-04-23 ~ 2021-03-31 |
| Kimball P Woodward | 30 Manitou Road, Westport, CT 06880 | Physician/surgeon | 1999-12-29 ~ 2000-12-31 |
| Bilal Kamal Alam | 8 Kimball Court, Burlington, MA 01803 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Juan M Perez Velazquez | Day Kimball Hospital, Putnam, CT 06260-1836 | Physician/surgeon | 2018-07-01 ~ 2019-06-30 |
| Denis R Baillargeon Md | Day Kimball Hospital Prof Bldg, Putnam, CT 06260 | Physician/surgeon | 2007-04-19 ~ 2008-06-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).