Provider Demographics
NPI:1518151554
Name:SABOURIN, KIM BANSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:BANSON
Last Name:SABOURIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BIG OAK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7801
Mailing Address - Country:US
Mailing Address - Phone:215-337-9420
Mailing Address - Fax:215-337-9423
Practice Address - Street 1:81 BIG OAK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7801
Practice Address - Country:US
Practice Address - Phone:215-337-9420
Practice Address - Fax:215-337-9423
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist