Provider Demographics
NPI:1164725800
Name:KIMMEL, KIMBERLY P
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1038
Mailing Address - Country:US
Mailing Address - Phone:315-245-2616
Mailing Address - Fax:
Practice Address - Street 1:1 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1038
Practice Address - Country:US
Practice Address - Phone:315-245-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58021455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist