Provider Demographics
NPI:1053465450
Name:GLISE, KIMBERLEY ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:GLISE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2373 VIEWCREST RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3156
Mailing Address - Country:US
Mailing Address - Phone:702-461-1353
Mailing Address - Fax:702-549-2608
Practice Address - Street 1:4600 E SUNSET RD
Practice Address - Street 2:SUITE 179
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2202
Practice Address - Country:US
Practice Address - Phone:702-461-5661
Practice Address - Fax:702-549-2608
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV SP-797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist