Provider Demographics
NPI:1740588813
Name:YON, KIMBERLY ADELEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ADELEEN
Last Name:YON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ADELEEN YON
Other - Last Name:GUILMET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:302 PONCE DE LEON PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5122
Mailing Address - Country:US
Mailing Address - Phone:404-932-0696
Mailing Address - Fax:404-973-0756
Practice Address - Street 1:302 PONCE DE LEON PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5122
Practice Address - Country:US
Practice Address - Phone:404-932-0696
Practice Address - Fax:404-973-0756
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16250235Z00000X
GASLP005950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110297BMedicaid