Provider Demographics
NPI:1679655211
Name:CARROLL, KIMBERLY A (MS, CCC-CLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS, CCC-CLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FLINTLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3266
Mailing Address - Country:US
Mailing Address - Phone:603-893-8550
Mailing Address - Fax:603-893-8680
Practice Address - Street 1:5 FLINTLOCK RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3266
Practice Address - Country:US
Practice Address - Phone:603-893-8550
Practice Address - Fax:603-893-8680
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6872235Z00000X
NH1060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist