Provider Demographics
NPI:1326187766
Name:WOOD, KIMBERLEY K (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:K
Last Name:WOOD
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 1:7820 N ROUNDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3915
Mailing Address - Country:US
Mailing Address - Phone:623-670-1198
Mailing Address - Fax:
Practice Address - Street 1:7820 N ROUNDSTONE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3915
Practice Address - Country:US
Practice Address - Phone:623-670-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805327Medicaid