Provider Demographics
NPI:1467650960
Name:FORNI, KIM R
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:R
Last Name:FORNI
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 1:8540 S EASTERN AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2834
Mailing Address - Country:US
Mailing Address - Phone:702-733-8255
Mailing Address - Fax:702-737-8255
Practice Address - Street 1:8540 S EASTERN AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2834
Practice Address - Country:US
Practice Address - Phone:702-733-8255
Practice Address - Fax:702-737-8255
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist