Provider Demographics
NPI:1568831188
Name:BACHMANN, KIMBERLY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BACHMANN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PLUMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9509
Mailing Address - Country:US
Mailing Address - Phone:732-558-2242
Mailing Address - Fax:
Practice Address - Street 1:115 PLUMSTEAD DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9509
Practice Address - Country:US
Practice Address - Phone:561-808-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00806900235Z00000X
FLSA15336222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist