Provider Demographics
NPI:1750501078
Name:HARDING, KIM JARED (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:JARED
Last Name:HARDING
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7566
Mailing Address - Country:US
Mailing Address - Phone:480-497-5248
Mailing Address - Fax:480-813-8506
Practice Address - Street 1:516 W MONTE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-7566
Practice Address - Country:US
Practice Address - Phone:480-497-5248
Practice Address - Fax:480-813-8506
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist