Provider Demographics
NPI:1821082512
Name:FORBES, KIMBALL B (MCD FAAA)
Entity Type:Individual
Prefix:MR
First Name:KIMBALL
Middle Name:B
Last Name:FORBES
Suffix:
Gender:M
Credentials:MCD FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:STE 360
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-688-8866
Mailing Address - Fax:435-688-2882
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:STE 360
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-688-8866
Practice Address - Fax:435-688-2882
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1090604101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R34308Medicare UPIN
R34308Medicare UPIN