Provider Demographics
NPI:1437277621
Name:JURGEMEYER, KIMBERLY DAWN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:JURGEMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GRAND AVE APT 82
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5013
Mailing Address - Country:US
Mailing Address - Phone:641-425-9711
Mailing Address - Fax:
Practice Address - Street 1:301 NE TRILEIN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2170
Practice Address - Country:US
Practice Address - Phone:515-965-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist