Provider Demographics
NPI:1215227228
Name:BREESE, KIMBERLY ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:BREESE
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 1:3531 E NORTHERN PKWY APT B3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1640
Mailing Address - Country:US
Mailing Address - Phone:410-444-9989
Mailing Address - Fax:
Practice Address - Street 1:200 PRESIDENT ST
Practice Address - Street 2:SUITE 230
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4580
Practice Address - Country:US
Practice Address - Phone:443-320-1033
Practice Address - Fax:443-320-1030
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist