Provider Demographics
NPI:1760239743
Name:BORDELON, KIMBERLY VARNADO (MS, L-SLP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VARNADO
Last Name:BORDELON
Suffix:
Gender:F
Credentials:MS, L-SLP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13909 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-6340
Mailing Address - Country:US
Mailing Address - Phone:225-686-7044
Mailing Address - Fax:225-686-4335
Practice Address - Street 1:24145 COATS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462-8119
Practice Address - Country:US
Practice Address - Phone:225-294-3306
Practice Address - Fax:225-294-3307
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist