Provider Demographics
NPI:1093813461
Name:BRIGGS, KIM B (MS CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:B
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 MERLIN DR
Mailing Address - Street 2:STE 200
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7405
Mailing Address - Country:US
Mailing Address - Phone:208-529-1514
Mailing Address - Fax:208-529-3170
Practice Address - Street 1:3345 MERLIN DR
Practice Address - Street 2:STE 200
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7405
Practice Address - Country:US
Practice Address - Phone:208-529-1514
Practice Address - Fax:208-529-3170
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-1030231HA2400X
IDAUD-1095231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807202100Medicaid