Provider Demographics
NPI:1508156688
Name:PETH, KIMBERLY KAY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:PETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:LAPERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3735 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2732
Mailing Address - Country:US
Mailing Address - Phone:949-922-2599
Mailing Address - Fax:
Practice Address - Street 1:3735 HILLCREST LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2732
Practice Address - Country:US
Practice Address - Phone:949-922-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA24172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant