Provider Demographics
NPI:1851782171
Name:LIMBERG, KATHRYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LIMBERG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MCINTOSH E
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1818
Mailing Address - Country:US
Mailing Address - Phone:608-385-2638
Mailing Address - Fax:
Practice Address - Street 1:66 SHADY OAK CT
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6034
Practice Address - Country:US
Practice Address - Phone:608-789-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3817-154235Z00000X
MN9147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist