Provider Demographics
NPI:1740614940
Name:VAN BUREN, KIMBERLY ROSE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROSE
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ROSE
Other - Last Name:CIFUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:105 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2409
Mailing Address - Country:US
Mailing Address - Phone:610-521-1331
Mailing Address - Fax:
Practice Address - Street 1:105 MORTON AVE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2409
Practice Address - Country:US
Practice Address - Phone:610-521-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-25
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011242235Z00000X
NY022463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist