Provider Demographics
NPI:1629125604
Name:CALLAHAN, KIM B (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3802
Mailing Address - Country:US
Mailing Address - Phone:701-227-0728
Mailing Address - Fax:701-264-1171
Practice Address - Street 1:1051 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3802
Practice Address - Country:US
Practice Address - Phone:701-227-0728
Practice Address - Fax:701-264-1171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND#331231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56207Medicaid
ND56207Medicaid