Provider Demographics
NPI:1629231253
Name:SANBORN, KIMBERLY FOS (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:FOS
Last Name:SANBORN
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 1:16038 DOCTORS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1478
Mailing Address - Country:US
Mailing Address - Phone:985-419-8080
Mailing Address - Fax:985-542-0282
Practice Address - Street 1:3545 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3138
Practice Address - Country:US
Practice Address - Phone:985-419-8080
Practice Address - Fax:985-542-0282
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5946231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter