Provider Demographics
NPI:1568757862
Name:CAUFIELD, KIMBERLY (SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAUFIELD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CAUFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:18057 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1738
Mailing Address - Country:US
Mailing Address - Phone:586-337-0436
Mailing Address - Fax:586-992-8919
Practice Address - Street 1:55264 NILE WAY
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-6194
Practice Address - Country:US
Practice Address - Phone:586-337-0436
Practice Address - Fax:586-992-8919
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12099907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist