Provider Demographics
NPI:1457652158
Name:KIMMELL, KRISTI WOOD (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:WOOD
Last Name:KIMMELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4706
Mailing Address - Country:US
Mailing Address - Phone:931-552-0369
Mailing Address - Fax:
Practice Address - Street 1:2158 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4706
Practice Address - Country:US
Practice Address - Phone:931-552-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist