Provider Demographics
NPI:1114236296
Name:NIEVES, KIMBERLY SUZANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:NIEVES
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 1:2217 IVAN ST
Mailing Address - Street 2:1021
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1074
Mailing Address - Country:US
Mailing Address - Phone:817-458-2908
Mailing Address - Fax:
Practice Address - Street 1:2217 IVAN ST
Practice Address - Street 2:1021
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1074
Practice Address - Country:US
Practice Address - Phone:817-458-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist