Provider Demographics
NPI:1760507453
Name:CATO, KIMBERLY ANNE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CATO
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 712
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:ID
Mailing Address - Zip Code:83332
Mailing Address - Country:US
Mailing Address - Phone:208-837-4021
Mailing Address - Fax:208-734-6795
Practice Address - Street 1:1201 FALLS AVE E
Practice Address - Street 2:SUITE 36
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-6700
Practice Address - Fax:208-734-6795
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSPE65OtherBLUE CROSS
ID000010142448OtherBLUE SHIELD