Provider Demographics
NPI:1497912596
Name:BENTLEY, KIMBERLY P (MSCCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MSCCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 FLUVANNA TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9779
Mailing Address - Country:US
Mailing Address - Phone:716-484-0119
Mailing Address - Fax:716-484-2666
Practice Address - Street 1:2914 FLUVANNA TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9779
Practice Address - Country:US
Practice Address - Phone:716-484-0119
Practice Address - Fax:716-484-2666
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist