Provider Demographics
NPI:1043608201
Name:THOMAS, KIMBERLY ANN (MA CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4137 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2201
Mailing Address - Country:US
Mailing Address - Phone:513-858-7153
Mailing Address - Fax:513-829-4311
Practice Address - Street 1:255 DONALD DRIVE
Practice Address - Street 2:FAIRFIELD INTER. SCHOOL
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-829-4311
Practice Address - Fax:513-829-7447
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.4597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist