Provider Demographics
NPI:1497419394
Name:CULLEN, KIMBERLY PATRICIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICIA
Last Name:CULLEN
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 1:79 CREST DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1404
Mailing Address - Country:US
Mailing Address - Phone:732-600-5857
Mailing Address - Fax:
Practice Address - Street 1:104 INTERCHANGE PLZ STE 103
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-2038
Practice Address - Country:US
Practice Address - Phone:732-617-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015670235Z00000X
NY030838235Z00000X
NJ41YS00956700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty