Provider Demographics
NPI:1720205800
Name:MAH, KIMBERLY T (MA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:T
Last Name:MAH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 W CARDINAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3338
Mailing Address - Country:US
Mailing Address - Phone:602-541-0320
Mailing Address - Fax:
Practice Address - Street 1:595 N DOBSON RD
Practice Address - Street 2:SUITE D-79
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4226
Practice Address - Country:US
Practice Address - Phone:480-899-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA4914231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist