Provider Demographics
NPI:1720362676
Name:STOVER, KIMBERLY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-675-1853
Mailing Address - Fax:308-210-4121
Practice Address - Street 1:3219 CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2949
Practice Address - Country:US
Practice Address - Phone:308-865-7182
Practice Address - Fax:308-865-2881
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist