Provider Demographics
NPI:1659634996
Name:RUDOLPH, KIMBERLY L (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8023
Mailing Address - Country:US
Mailing Address - Phone:732-818-3610
Mailing Address - Fax:732-818-3663
Practice Address - Street 1:250 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8023
Practice Address - Country:US
Practice Address - Phone:732-818-3610
Practice Address - Fax:732-818-3663
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00082300231H00000X
NJ25MG000125800237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist