Provider Demographics
NPI:1235805821
Name:WALKER, KIMBERLY ELAINE (MS,SLP CCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS,SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 DAVISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:KY
Mailing Address - Zip Code:40347-9734
Mailing Address - Country:US
Mailing Address - Phone:859-699-3491
Mailing Address - Fax:
Practice Address - Street 1:101 SEXTON WAY
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-7800
Practice Address - Country:US
Practice Address - Phone:859-846-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist