Provider Demographics
NPI:1437392412
Name:KIMBERLIN, KIMBERLEY L (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:L
Last Name:KIMBERLIN
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1657
Mailing Address - Street 2:104 N. SANDERS AVE. HEARTLAND REHABILITATION SERVICES O
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319
Mailing Address - Country:US
Mailing Address - Phone:276-646-8774
Mailing Address - Fax:276-646-5576
Practice Address - Street 1:104 N. SANDERS AVE.
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC.
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319
Practice Address - Country:US
Practice Address - Phone:276-646-8774
Practice Address - Fax:276-646-5576
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist