Provider Demographics
NPI:1437930716
Name:KIMBLE, LEIGH (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 HUERFANO AVE UNIT 345
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5297
Mailing Address - Country:US
Mailing Address - Phone:520-343-1283
Mailing Address - Fax:
Practice Address - Street 1:235 NUTMEG ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6201
Practice Address - Country:US
Practice Address - Phone:619-239-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist