Basic Information
| Provider Information | |||||||||
| NPI: | 1437745270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 MCLEAN ST | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482033309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109239498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1255 W SILVERBELL RD | ||||||||
| Address2: | |||||||||
| City: | LAKE ORION | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483591345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483910900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2020 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.