Provider Demographics
NPI:1497907521
Name:VANDERMARK, KIMBERLY A (CCC-SLP, TSHH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:VANDERMARK
Suffix:
Gender:F
Credentials:CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3404
Mailing Address - Country:US
Mailing Address - Phone:845-541-6168
Mailing Address - Fax:
Practice Address - Street 1:952 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3404
Practice Address - Country:US
Practice Address - Phone:845-541-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013651235Z00000X
NVSP-3499235Z00000X
VA2202008417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist