Provider Demographics
NPI:1518237130
Name:HETHERINGTON, KIMBERLY LAUREN (MA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:985-898-2999
Mailing Address - Fax:985-898-2289
Practice Address - Street 1:201 HOLIDAY BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5088
Practice Address - Country:US
Practice Address - Phone:985-898-2999
Practice Address - Fax:985-898-2289
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist