Basic Information
| Provider Information | |||||||||
| NPI: | 1265079958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUMMINGS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | COLLEEN | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199759300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024361000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31 HOSIER ST | ||||||||
| Address2: | |||||||||
| City: | SELBYVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199759300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024361000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2019 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | O1-0001792 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.