Provider Demographics
NPI:1417247933
Name:KIMBALL, TRICIA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANN
Last Name:KIMBALL
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 1:55 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3862
Mailing Address - Country:US
Mailing Address - Phone:912-344-1505
Mailing Address - Fax:
Practice Address - Street 1:106 OGLETHORPE PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3693
Practice Address - Country:US
Practice Address - Phone:912-351-4793
Practice Address - Fax:888-429-3741
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist