Provider Demographics
NPI:1821401647
Name:SWETT, KIM MACHTOLFF (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MACHTOLFF
Last Name:SWETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 TYCOON WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1512
Mailing Address - Country:US
Mailing Address - Phone:502-595-7824
Mailing Address - Fax:
Practice Address - Street 1:4603 TIMBERWALK CT
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6746
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:888-830-3233
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist