Provider Demographics
NPI:1265482681
Name:HINKS, KIMBERLY KAYE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:HINKS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAYE
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34135 N NEEDLEGRASS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5210
Mailing Address - Country:US
Mailing Address - Phone:224-522-5315
Mailing Address - Fax:847-984-1160
Practice Address - Street 1:34135 N NEEDLEGRASS DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5210
Practice Address - Country:US
Practice Address - Phone:224-522-5315
Practice Address - Fax:847-984-1160
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
IL146007781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932537OtherBCBS PROVIDER NUMBER