Provider Demographics
NPI:1831317767
Name:BLOCK, KIMBERLY L (AUD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:BLOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 GOLD HILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8988
Mailing Address - Country:US
Mailing Address - Phone:803-620-8250
Mailing Address - Fax:803-638-6901
Practice Address - Street 1:870 GOLD HILL RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8988
Practice Address - Country:US
Practice Address - Phone:803-620-8250
Practice Address - Fax:803-638-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9758231H00000X, 237600000X
SC4011237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831317767Medicaid
NCQ39159AMedicare PIN