Provider Demographics
NPI:1376683847
Name:SHEWMAKER, KIMBERLY A (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SHEWMAKER
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 1:1817 CROSS DRAW TRAIL
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-930-5439
Mailing Address - Fax:512-930-5431
Practice Address - Street 1:1520 LEANDER ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-930-5439
Practice Address - Fax:512-930-5431
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist