Provider Demographics
NPI:1790990703
Name:WARD, KIMBERLY LAURIN
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LAURIN
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SAGE RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6995
Mailing Address - Country:US
Mailing Address - Phone:919-928-0204
Mailing Address - Fax:919-928-9423
Practice Address - Street 1:205 SAGE RD
Practice Address - Street 2:STE 203
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6995
Practice Address - Country:US
Practice Address - Phone:919-928-0204
Practice Address - Fax:919-928-9423
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413132Medicaid