Provider Demographics
NPI:1407081284
Name:THOMPSON, KIMBERLY DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3030 S JONES BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6793
Mailing Address - Country:US
Mailing Address - Phone:702-360-1137
Mailing Address - Fax:702-341-1511
Practice Address - Street 1:3030 S JONES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6793
Practice Address - Country:US
Practice Address - Phone:702-360-1137
Practice Address - Fax:702-341-1511
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1354235Z00000X
TX105049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist