Provider Demographics
NPI:1588635924
Name:SHORR, KIM C (AUD FAAA)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:C
Last Name:SHORR
Suffix:
Gender:F
Credentials:AUD FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4835
Mailing Address - Country:US
Mailing Address - Phone:614-257-5815
Mailing Address - Fax:
Practice Address - Street 1:1955 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4835
Practice Address - Country:US
Practice Address - Phone:614-257-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid
OH4045751Medicare ID - Type Unspecified