Provider Demographics
NPI:1366641144
Name:ANNESE, KIM MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:ANNESE
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 1:11 YEW RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3703
Mailing Address - Country:US
Mailing Address - Phone:302-737-3343
Mailing Address - Fax:302-737-3343
Practice Address - Street 1:32 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4660
Practice Address - Country:US
Practice Address - Phone:302-358-2580
Practice Address - Fax:302-326-4132
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist