Basic Information
| Provider Information | |||||||||
| NPI: | 1437392412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBERLIN | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SPEECH LANGUAGE PATH | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1657 | ||||||||
| Address2: | 104 N. SANDERS AVE. HEARTLAND REHABILITATION SERVICES O | ||||||||
| City: | CHILHOWIE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766468774 | ||||||||
| FaxNumber: | 2766465576 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 N. SANDERS AVE. | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC. | ||||||||
| City: | CHILHOWIE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766468774 | ||||||||
| FaxNumber: | 2766465576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2009 | ||||||||
| LastUpdateDate: | 04/07/2009 | ||||||||
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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 | 2202002933 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.