Provider Demographics
NPI:1851339964
Name:HULL, KIMBERLY FAYE (MS, CCC/SLP, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:FAYE
Last Name:HULL
Suffix:
Gender:F
Credentials:MS, CCC/SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18288 N U.S. HWY 41
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549
Mailing Address - Country:US
Mailing Address - Phone:813-527-9638
Mailing Address - Fax:813-867-7288
Practice Address - Street 1:18288 N U.S. HWY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549
Practice Address - Country:US
Practice Address - Phone:813-527-9638
Practice Address - Fax:813-867-7288
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-02-0790103K00000X
FLSA 7688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004621200Medicaid
FLHV468AMedicare PIN