Provider Demographics
NPI:1700046091
Name:PLACE, KIMBERLY DEANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DEANN
Last Name:PLACE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:DEANN
Other - Last Name:WHITESIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1349 EMPIRE CENTRAL DR
Mailing Address - Street 2:SUITE 516
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4066
Mailing Address - Country:US
Mailing Address - Phone:469-364-8600
Mailing Address - Fax:469-364-8595
Practice Address - Street 1:1349 EMPIRE CENTRAL DR
Practice Address - Street 2:SUITE 516
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4066
Practice Address - Country:US
Practice Address - Phone:469-364-8600
Practice Address - Fax:469-364-8595
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist