Provider Demographics
NPI:1306038641
Name:STEPHENS, KIM MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:SILBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 875
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0875
Mailing Address - Country:US
Mailing Address - Phone:719-237-7757
Mailing Address - Fax:
Practice Address - Street 1:18330 GUIRE WAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7933
Practice Address - Country:US
Practice Address - Phone:719-237-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0308034OtherCOLORADO DEPT. OF ED