Provider Demographics
NPI:1346622065
Name:MCWHORTER, KIMBRE LACY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBRE
Middle Name:LACY
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 COMMERCE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7431
Mailing Address - Country:US
Mailing Address - Phone:858-254-0550
Mailing Address - Fax:
Practice Address - Street 1:10255 COMMERCE DR STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7431
Practice Address - Country:US
Practice Address - Phone:858-254-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15004235Z00000X
IN22007434A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist