Provider Demographics
NPI:1508010281
Name:GILWORTH, KIMBERLY JOYCE HUETER (MA, CCC-SLP, JD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JOYCE HUETER
Last Name:GILWORTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 HIGHWAY 234
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9313
Mailing Address - Country:US
Mailing Address - Phone:541-826-7998
Mailing Address - Fax:
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-789-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist