Provider Demographics
NPI:1326347691
Name:KIMAN, JOANNE BELLE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:BELLE
Last Name:KIMAN
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3117
Mailing Address - Country:US
Mailing Address - Phone:516-241-8544
Mailing Address - Fax:516-248-4221
Practice Address - Street 1:13 CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3117
Practice Address - Country:US
Practice Address - Phone:516-241-8544
Practice Address - Fax:516-248-4221
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000547-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000547-1OtherNYS SPEECH LICENSE