Provider Demographics
NPI:1154848174
Name:HALL, KIMBERLY L (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:HALL
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 1:106 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GILMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60938-1331
Mailing Address - Country:US
Mailing Address - Phone:815-683-2662
Mailing Address - Fax:
Practice Address - Street 1:101 LOCUST ST.
Practice Address - Street 2:
Practice Address - City:DANFORTH
Practice Address - State:IL
Practice Address - Zip Code:60930
Practice Address - Country:US
Practice Address - Phone:815-269-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist