Provider Demographics
NPI:1619309804
Name:ROLLINGS, KIMBERLY R (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:ROLLINGS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MENTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AU D
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3170
Mailing Address - Fax:812-235-3330
Practice Address - Street 1:1429 NORTH SIXTH STREET
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807
Practice Address - Country:US
Practice Address - Phone:812-234-3788
Practice Address - Fax:812-235-3330
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002535A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265130007Medicare PIN