Provider Demographics
NPI:1710198098
Name:KNIEBUEHLER, KIMBERLY S (SLP-A)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:KNIEBUEHLER
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-A
Mailing Address - Street 1:2801 N GANTENBEIN AVE
Mailing Address - Street 2:NICU
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:503-518-9321
Mailing Address - Fax:
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:NICU
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-518-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist