Provider Demographics
NPI:1720036015
Name:NIDAY, KIMBERLY JANE (MA, CCC/A)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JANE
Last Name:NIDAY
Suffix:
Gender:F
Credentials:MA, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N. MARIO CAPECCHI DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1100
Mailing Address - Country:US
Mailing Address - Phone:801-662-1000
Mailing Address - Fax:801-662-4930
Practice Address - Street 1:100 N. MARIO CAPECCHI DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1100
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:801-662-4930
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21574231H00000X
UT7789480-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist