Provider Demographics
NPI:1497082283
Name:LEVINE, KIMBERLY M (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:M
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 RICH HILL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4771
Mailing Address - Country:US
Mailing Address - Phone:916-718-2268
Mailing Address - Fax:916-258-0246
Practice Address - Street 1:5933 RICH HILL DR
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4771
Practice Address - Country:US
Practice Address - Phone:916-718-2268
Practice Address - Fax:916-258-0246
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist