Provider Demographics
NPI:1598911331
Name:HAVARD, KIM SCOTT (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:SCOTT
Last Name:HAVARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TEDINGTON
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7790
Mailing Address - Country:US
Mailing Address - Phone:601-408-1365
Mailing Address - Fax:601-450-2521
Practice Address - Street 1:31 TEDINGTON
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7790
Practice Address - Country:US
Practice Address - Phone:601-408-1365
Practice Address - Fax:601-450-2521
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist