Provider Demographics
NPI:1659323277
Name:STILL, KIMBER MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBER
Middle Name:MICHELLE
Last Name:STILL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SIGNATURE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8669
Mailing Address - Country:US
Mailing Address - Phone:903-293-0927
Mailing Address - Fax:
Practice Address - Street 1:130 SIGNATURE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8669
Practice Address - Country:US
Practice Address - Phone:903-293-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP7881235Z00000X
ARSP#2385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157906721Medicaid
AR5Y581OtherBLUE CROSS BLUE SHIELD