Provider Demographics
NPI:1790076867
Name:COKER, KIMBERLY CHACHERE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHACHERE
Last Name:COKER
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 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:469-800-7734
Mailing Address - Fax:469-800-7731
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:469-800-7734
Practice Address - Fax:469-800-7731
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist