Basic Information
| Provider Information | |||||||||
| NPI: | 1750809885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 PRAIRIE LAKE DR | ||||||||
| Address2: | |||||||||
| City: | FERN PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327302025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212390509 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 E OAK ST | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327034352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078802266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2017 | ||||||||
| LastUpdateDate: | 09/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA6879 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.