Provider Demographics
NPI:1225389844
Name:TEES, KIMBERLY W (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:W
Last Name:TEES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WILDERMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1478 GREENWAY PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1478 GREENWAY PL
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8335
Practice Address - Country:US
Practice Address - Phone:904-412-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist