Basic Information
| Provider Information | |||||||||
| NPI: | 1912523598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SODERBERG | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ERIN | ||||||||
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| Credential: | CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | W144N9723 ELMWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530226609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623858074 | ||||||||
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| Practice Location | |||||||||
| Address1: | 452 N EOLA RD STE A | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883083728 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2020 | ||||||||
| LastUpdateDate: | 06/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 242.005893 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.