Provider Demographics
NPI:1821235227
Name:MUCKLEROY, KIMBERLY (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:MUCKLEROY
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:MUCKLEROY
Other - Last Name:DI DONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:1736 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2810
Mailing Address - Country:US
Mailing Address - Phone:720-325-0031
Mailing Address - Fax:
Practice Address - Street 1:1736 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2810
Practice Address - Country:US
Practice Address - Phone:720-325-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12119912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist