Provider Demographics
NPI:1578615035
Name:KIMPLE, MARYA SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:MARYA
Middle Name:SUSAN
Last Name:KIMPLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARYA
Other - Middle Name:SUSAN
Other - Last Name:HERZBRUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 SOUTHGATE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1413
Mailing Address - Country:US
Mailing Address - Phone:650-758-5363
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTHGATE AVE
Practice Address - Street 2:STE 210
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1413
Practice Address - Country:US
Practice Address - Phone:650-758-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2520231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist