Provider Demographics
NPI:1346559986
Name:EASTMAN, KIMBLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBLE
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HALEY CENTER
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-5232
Mailing Address - Country:US
Mailing Address - Phone:334-844-9600
Mailing Address - Fax:334-844-4585
Practice Address - Street 1:1199 HALEY CENTER
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-5232
Practice Address - Country:US
Practice Address - Phone:334-844-9600
Practice Address - Fax:334-844-4585
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant