Provider Demographics
NPI:1568749851
Name:CARPENTER, KIMBERLEY ANNE (MA, SLP-CCC)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:MRS
Other - First Name:KIMBERLEY
Other - Middle Name:ANNE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA SLP-CCC
Mailing Address - Street 1:1 HALLETT CT
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1220
Mailing Address - Country:US
Mailing Address - Phone:516-592-7626
Mailing Address - Fax:
Practice Address - Street 1:1 HALLETT CT
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-1220
Practice Address - Country:US
Practice Address - Phone:516-592-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0176101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist