Provider Demographics
NPI:1629226345
Name:BERNER, KIMBERLEE YOUNG (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:YOUNG
Last Name:BERNER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SANDHILLS CIR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7034
Mailing Address - Country:US
Mailing Address - Phone:910-255-6157
Mailing Address - Fax:707-461-6244
Practice Address - Street 1:5 DOWD CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7901
Practice Address - Country:US
Practice Address - Phone:910-255-6157
Practice Address - Fax:707-461-6244
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15155235Z00000X
NC11094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist