Provider Demographics
NPI:1790278810
Name:BARTLOME, KIMBERLY NICHOLE (HAS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:BARTLOME
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36701 AMERICAN WAY STE 8B
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4063
Mailing Address - Country:US
Mailing Address - Phone:440-934-9344
Mailing Address - Fax:
Practice Address - Street 1:36701 AMERICAN WAY STE 8B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4063
Practice Address - Country:US
Practice Address - Phone:440-934-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03367237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03367OtherOHIO HEARING AND SPEECH BOARD