Provider Demographics
NPI:1669628491
Name:MARTINDALE, KIM KATHLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:KATHLEEN
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 34418
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4418
Mailing Address - Country:US
Mailing Address - Phone:775-787-0357
Mailing Address - Fax:
Practice Address - Street 1:8345 MESA PARK RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9781
Practice Address - Country:US
Practice Address - Phone:775-787-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist