Basic Information
| Provider Information | |||||||||
| NPI: | 1821007873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLABORN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1071 W BLUE STARR DR | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740172638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183414343 | ||||||||
| FaxNumber: | 9183418687 | ||||||||
| Practice Location | |||||||||
| Address1: | 1071 W BLUE STARR DR | ||||||||
| Address2: | |||||||||
| City: | CLAREMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740172638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183414343 | ||||||||
| FaxNumber: | 9183418687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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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 | 2016 | OK | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 100637590C | 05 | OK | MEDICAID |