Provider Demographics
NPI:1679210058
Name:YAMASHITA, KIMBERLY RANAE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RANAE
Last Name:YAMASHITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 W 4925 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-7700
Mailing Address - Country:US
Mailing Address - Phone:801-710-0053
Mailing Address - Fax:
Practice Address - Street 1:5320 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6913
Practice Address - Country:US
Practice Address - Phone:801-476-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist